[Mr. Speaker  in the  Chair]

PRIVATE BUSINESS

London Local Authorities (Shopping Bags) Bill  (By Order)

Order for Second Reading read.
	 To be read a Second time on Thursday 23 October.

Manchester City Council Bill  [Lords] (By Order)

Order read for resumed adjourned debate on Second Reading (12 June) , That the Bill be read a Second time .
	 Debate to be resumed on Wednesday 29 October at Four o'clock.

Bournemouth Borough Council  [Lords] (By Order)
	 — 
	Canterbury City Council Bill ( By Order)
	 — 
	Leeds City Council Bill  (By Order)
	 — 
	Nottingham City Council Bill  (By Order)
	 — 
	Reading Borough Council Bill ( By Order)

Orders for Second Reading read.
	 To be read a Second time on Wednesday 29 October at Four o'clock.

ORAL ANSWERS TO QUESTIONS

INNOVATION, UNIVERSITIES AND SKILLS

The Secretary of State was asked—

Apprenticeships

Jim Sheridan: What steps his Department is taking to support the provision of apprenticeships in the construction industry in the current economic situation.

John Denham: Despite the current economic crisis, the most recent construction skills estimate was that there would be more than 40,000 new entrants to the industry every year. We are determined to maintain the highest possible numbers of apprentices in the sector, so we are looking at how we can use the power of Government contracts to increase the number of apprenticeship places. We have set up a clearing house, which has already placed two thirds of apprentices who risk losing their apprenticeships with a new employer or training provider, and convened a group of employers and trade unions to advise us on other practical steps that we can take to support the sector. I am clear that we must be prepared to consider new and radical ways of promoting and supporting apprenticeships in the current economic conditions.

Jim Sheridan: I thank my right hon. Friend for that response. He will be aware that despite the economic crisis in the construction industry, there are still some good employers who spend money and time training their employees. However, they are being undermined by unregistered rogue employers who do not pay tax or insurance, thereby undermining the good employers and their businesses. Could my right hon. Friend therefore ensure that, all things being equal, Government procurement contracts are given only to those registered companies with a track record of investing in training?

John Denham: My hon. Friend raises an important point. He will know that in the £2.3 billion capital programme for further education colleges in England we have already made it clear that major new contracts will have to have a training agreement within them. I can assure him that I am discussing that message actively with colleagues across Government, so that we look into every area of Government procurement to see how it can be used to secure the maximum training and the maximum numbers of apprentices.

Phil Willis: I am very supportive of the Government's approach towards apprenticeships, and I think that I speak for my colleagues on the Front Bench when I say that. However, there is a concern, not only about construction apprenticeships, but about other apprenticeships. At the end of the last financial year, £284 million was taken out of the learning and skills budget, £128 million of which was given to higher education to support student grants. How does that attune with what the Secretary of State has said about trying to get more apprenticeships, to meet the target of 500,000 that Lord Leitch set and which the Government supported, and will that money go back to the Learning and Skills Council?

John Denham: I am grateful for the hon. Gentleman's support. We have made it clear through the Learning and Skills Council that we do not want any shortage of money to be a constraint on the number of apprenticeships and we have reinforced that in the past year. There are one or two examples at the local or regional level of people saying that there is no budget for apprenticeships. We have overruled that and made it clear that we will expand the financing going into apprenticeships to meet the demand that comes from employers. With regard to last year's budget, the hon. Gentleman will know that £115 million of underspend last year, the first year of the Train to Gain programme, was reinvested in the further education and skills budget. However, I am more than happy to write to him and the Select Committee on Innovation, Universities, Science and Skills to explain how that was done.

David Taylor: A substantial expansion of the newly restored rights of local authorities to build council housing linked to a requirement to take on apprenticeships would be a useful step forward. We have seen the number of apprentices double over 10 years and that is great, but 19 out of 20 employers still have no scheme. Does my right hon. Friend agree that one of the reasons for that might be the paperwork associated with accessing public money for apprenticeships? The paperwork is quite substantial, ranging from the monitoring of quality assurance to retaining data on every apprenticeship for at least six years. Is there not a simpler way of approaching the matter?

John Denham: My hon. Friend raises a very important point. I had quite a lively meeting in my office in July with a number of people from different parts of the apprenticeship system. The farce of people believing that they had to keep vocational qualification documents for six years in paper form for audit purposes is being dealt with, as is the fact that people could not get their accreditation online and had to use a paper-based process. Some of the accrediting bodies are already removing that practice from their procedures. So I can assure my hon. Friend that, whether we are talking about public sector apprenticeships—where the numbers are expanding rapidly—or more private sector apprenticeships, we are determined to deal with the bureaucracy that has been an inhibition in the past.

Nicholas Winterton: I have worked in the construction industry, and I have to say that I am quite encouraged by the Secretary of State's remarks. There is no doubt, however, that further trained personnel—particularly craftsmen—are required in the industry, and there should be additional apprenticeships available. At the moment, the industry sucks in too many people from overseas to fill the positions that are vacant. Will the Secretary of State take seriously the points that have been made on both sides of the House on this question?

John Denham: Yes, I will. The hon. Gentleman has raised an important point. I never want us to be in a position where someone in this country loses a job that goes to somebody from another country—whether that person comes here to do the job or whether the job goes there—just on the basis that they do not have the necessary skills. I am determined to ensure that we do not ignore untapped talent in this country, resulting in people losing out. We will look at new ways of approaching the situation, and the hon. Gentleman is quite right to suggest that projects such as the Olympics, the major Crossrail programme and the Government's public sector housing programme will all draw people into the industry, even though the private house building market is very slow at the moment. We will need to look at new ways of doing this, recognising that smaller companies might find it a little more difficult financially than it has been in the past. We will look at those new ways of ensuring that we have a supply of skilled labour.

William McCrea: Will the Secretary of State accept that there is an urgent need right across the United Kingdom to grant the skilled training of apprentices in the construction industry a higher professional qualification and recognition by society?

John Denham: The hon. Gentleman is quite right to raise the question of qualification levels. I want as many apprentices as possible to get the level of advanced qualification that will give them the ability to work on any building site. The other thing that the Government will be doing a lot more of in the next year is promoting the apprenticeship to its real value in society, as a legitimate means of training. Apprenticeships had disappeared in 1997; few people started them, and very few of those people finished them. We have rescued apprenticeships, but we are still on the journey to restoring their rightful position as a mainstream option in the training and education system in this country. That is what we are determined to do.

John Hayes: It is good to be questioning the Secretary of State, rather than one of the two novices sitting either side of him—[Hon. Members: "Oh!"] But I do not want to be ungenerous. In 2003, the Prime Minister promised that apprenticeship numbers would rise to 320,000. We know that, today, there are just 240,000, and that level 3 apprenticeships have been falling every year since 2000. If the Government are really serious about apprenticeships, will they adopt some of the policies outlined in our green paper? Those include equalising funding for people over 18 doing apprenticeships, providing a cash bonus of £2,000 per apprentice to small and medium-sized enterprises, and helping group training associations, which would again help smaller companies to take apprenticeships seriously and boost their numbers. The Conservatives believe in apprenticeships. Does the right hon. Gentleman, or is it just more fine words and failed policies?

John Denham: I am sorry that the hon. Gentleman has started in such a disgruntled way. A few points off the Conservatives' lead in the opinion polls have obviously put him in a very bad mood indeed.
	Let me deal with a few of the statistics, although not all of them. The hon. Gentleman really should not confuse the real progress that we have made with the long-term targets for apprenticeship numbers that we are determined to achieve. They were set out in the Leitch report and we are working towards them. Let us look at advanced apprenticeships. The number of people achieving that qualification—which is what matters—has more than doubled under this Government. Of course, there was a time when there were far fewer apprenticeships, they were all called level 3 and nobody completed them. That was the apprenticeship system under the previous Conservative Government. At that time, no public money was going into apprenticeships.
	I was very glad that the policy on group training associations announced by the Conservatives during the summer mimicked directly the one that we had announced in January. I was also very glad that their support for wage compensation for small employers mimicked directly the policy already implemented by this Government. It is really quite ridiculous for the Conservatives to go through our policies, repeat them and then claim that that is evidence of their support for apprenticeships.

NEETs

Stephen Crabb: How many young people were not in education, employment or training in the latest period for which figures are available.

John Denham: The latest figures show that there were 730,000 young people aged 18 to 24 who were not in education, employment or training in England. Around 260,000 of those young adults have caring responsibilities and a further 78,000 have a disability or sickness. Since April this year, we have made it possible for 18-year-olds with a history of not being in employment, education or training to be fast-tracked through the new deal programme on a voluntary basis; and from April next year, early entry to the new deal will be mandatory for 18-year-olds who have been in the NEET category for six months. Since 1997, the Government have increased the numbers of young people active in work or education from 3.9 million to 4.7 million. Through the measures we have taken, we aim to continue that progress.

Stephen Crabb: I am grateful to the Secretary of State for that response, but notwithstanding the measures and results he referred to, one of the principal stains on this Government's reputation is without question that during a decade of economic growth, rising employment and falling unemployment, hundreds of thousands of young people were allowed to fall through the net and effectively do nothing with their lives as they were not in education, not in training and not in the apprenticeships that the right hon. Gentleman mentioned earlier. Now, at a time of economic hardship when jobs are being shed and the cupboards are bare, will the Secretary of State please tell us what measures he can bring to the table today that suggest that he knows how to bring down the number of NEETs at a time of economic difficulty?

John Denham: First, at the risk of repeating myself, what was achieved in the decade of growth was a huge increase in the number of young people in education and employment and, of course, a dramatic reduction over the same period in long-term youth unemployment. The hon. Gentleman is right that, within the overall number of NEETs—it is a much smaller number than in the past—who do not have caring responsibilities, who are not out of work and bringing up their families, who are not among the 80,000 owning or buying their own homes and so living in households with significant incomes, there is a core of people about whom we remain worried.
	I would say to Conservative Members, however, that opposition to increasing the participation age for training and work is the worst possible policy. The best way of ensuring that young people do not end up out of work, out of training and out of education is to ensure that, between 16 and 18, they are either in college or in work with training. I regret the fact that the Conservative party rejects the most practical measure that the Government are putting in place to deal with the issue in the longer term.

Mary Creagh: Second only to the Isles of Scilly, Wakefield has the second highest rate in the country of young people not in education, employment or training. With 11 per cent. of 16-year-olds classified as NEETs and just 22 per cent. progressing to higher education at 18, despite our excellent GCSE results, will my right hon. Friend sit down with me, Wakefield council and Wakefield college to discuss what can be done to stop that tragic waste of talent during the years before the secondary school age rises to 18?

John Denham: I would be delighted to do so. I know that my hon. Friend is very keen on the development in her area of a stronger offer for higher education. Part of the challenge—it is only part of it—is to make sure that the aspirations of young people of talent and ability are raised to the highest possible level. In some parts of the country, local access to higher education is not as strong as it could be. The Higher Education Funding Council will shortly end its consultation on our new university challenge, which might be one of the issues that we should discuss for Wakefield. A number of other Members have a similar interest for their areas.

Julie Kirkbride: Has the Secretary of State had a chance to look at  The Daily Telegraph this morning? If so, he will have seen an excellent article by the right hon. Member for Birkenhead (Mr. Field), a former welfare Minister, in which he points out that the number of NEETs under this Labour Government is now at record levels and suggests that the new deal should be scrapped for having failed young people and that the money saved should be spent on better projects in order to deal with the forthcoming economic difficulties that the country faces.

John Denham: I shall undoubtedly read the article with great interest. It is difficult for me to comment, given that I have not seen the article or the statistics that it contains, but I can say that some of the statistics that are currently in play are very misleading. I do not think it fair— [Interruption.] May I be allowed to make my point? I think that the hon. Lady will agree with me.
	If, for example, a mother decides to stay at home looking after her children and to study part-time, she will appear as a NEET in some statistics, but I do not think that a mother who chooses to do that should be labelled as someone who is not doing something useful or active, and the same applies to others with caring responsibilities. We must accept that there is a much smaller but, yes, hard-core problem involving those who have dropped out of the system and are not engaged in education and training, but I believe that the higher level of conditionality on benefit and the much earlier intervention with young people—particularly those who have already been out of work for a couple of years before reaching the age of 18—is the way to go.
	Those core principles are at the heart of the new deal, and my right hon. Friend the Secretary of State for Work and Pensions is making very clear that much more active and much earlier intervention involving more young people is the key to ensuring that they do not stay outside the employment, training and education system for long periods.

Higher Education (Knowsley)

George Howarth: What discussions he has had on the establishment of a higher education campus in Knowsley.

David Lammy: We are very encouraged by the interest in our new university challenge policy, and want to extend the benefits of higher education to more people and places. If any proposals are developed, in Knowsley or elsewhere, we shall be happy to meet delegations led by hon. Members to discuss them.

George Howarth: I am grateful to my hon. Friend for his answer. Does he agree that the collaboration involving Edge Hill university in Knowsley and efforts to provide more higher education opportunities at Knowsley community college will pave the way towards establishing a campus in Knowsley?

David Lammy: My right hon. Friend raised this matter with me during my first week in the job. He is absolutely right: the work between the further education college and the higher education college, and the establishment of a new university, are bound to promote regeneration and opportunities for both young people and adults in that part of the north-west. I am very keen to talk to my right hon. Friend further about any proposals. The decisions will of course be made by the HEFCE, but there is currently a great deal of enthusiasm across the country about new universities. That suggests that there is a lot of unmet need out there, which our policy is supporting.

Research Careers

Phil Wilson: What steps his Department is taking to promote careers in research.

David Lammy: The Government are currently looking at Professor Nigel Thrift's review of research careers in the UK, commissioned as part of the higher education debate launched earlier this year. We expect it to help in developing our approach to higher education and research careers in the longer term.

Phil Wilson: There has been a 100 per cent. pass rate in all science subjects among students at Woodham community technology college in my constituency. What is the Department doing to ensure that those young people's fascination with science today turns into successful careers in science tomorrow?

David Lammy: I applaud the work being done in my hon. Friend's constituency, which places the institution to which he referred among the very best in the country. He is absolutely right: encouraging an ability in and an enthusiasm for science among young people is key to the country's success in the coming years, and we are working closely with our colleagues in the Department for Children, Schools and Families to achieve that. It is important that young adult scientists are returning to schools, and we are supporting that through our science and engineering ambassadors throughout the country. It is also important that we are supporting young people in those key stem subjects—chemistry, physics and mathematics—with an extra £15 million of investment over the next year.

Evan Harris: I welcome the Minister to his new responsibilities in relation to science. Does he recognise the particular challenge involved in recruiting and retaining women in research careers? Given that they leave universities with high levels of debt, face a continuing pay gap and, indeed, publication gaps due to family commitments, and given that we are starting from a low base—especially in some areas—is there not a particular need for Government to give research councils and other employers the tools to enable us to do better by women in science? We need to retain their talents in research.

David Lammy: The hon. Gentleman is absolutely right. He will, I hope, be aware of the work of my hon. Friend the Member for Crosby (Mrs. Curtis-Thomas) to ensure that women are represented in science and engineering. Indeed, I did some work about that with my hon. Friend in my previous role as Minster with responsibility for skills. The Government have provided direct funding, including pilot funding, to encourage women in those spheres. We are also working with training organisations and trade bodies, particularly in engineering and science, to support women in their careers, including when they are on career breaks because we recognise that when women who have been trained and have an extensive science background leave work to have children, they often come back into science employment at a lower grade, or are unable to regain the positions that they left. We want to support the work of those organisations and trade bodies to ensure that those women are pioneers within science.

Scientific Research

Kerry McCarthy: What steps he plans to take to improve public confidence in scientific research.

John Denham: Earlier this year, when I addressed the Royal Society for the encouragement of Arts, Manufactures and Commerce, I said that our ambition should be to go further than scientific literacy to a more mature relationship between the public, the media and scientists, where everyone understands each other. In particular, that means the public and the media maintaining the same healthy scepticism towards science that they do towards other information that they consume. We are currently consulting on a new vision for science and society, with a key strand focused on creating a society confident in the use of science. That will build on the good work that we already support such as funding the Sciencewise Expert Resource Centre.

Kerry McCarthy: I thank the Minister for that response. One of the less welcome consequences of the UK's success in scientific research has been the increase in the number of animal experiments being carried out year on year. I welcome the fact that his Department has increased funding to look at alternatives to the use of animals in research, but can he assure the House that, as we seek to promote and support our scientific research sector, we will also try to ensure that that research is conducted as ethically and humanely as possible?

John Denham: Yes. I recognise the concerns that my hon. Friend has expressed, which are quite widely held across society. We believe that there is potential to make advances in science and to reduce animal use. Some recent scientific advances, including tissue engineering, stem cell research and imaging technologies, have that potential. She will be aware that the Government have funded the National Centre for the Replacement, Refinement and Reduction of Animals in Research, or NC3Rs as it is known, which is the first centre of its type in the world. The two research councils will give £12.8 million to that centre over the coming three years.

Mark Harper: The Secretary of State will know that, in 2002, in a speech to the Royal Society, Tony Blair said:
	"The benefits of science will only be realised through a renewed compact between science and society."
	The Secretary of State set out some recent things that the Government have done, but what did they do over that six-year period to renew that compact between science and society?

John Denham: We did a number of things. The development of the sciencewise process meant that the Government increased not only their ability to consult with the public carefully and sensitively on controversial issues, but how to handle them. We were involved in encouraging the setting up of the science media centre, which is independent of Government, as it needs to be, and it has been critically important.
	In some of the major issues, for example, the MMR vaccine case, one of the problems was that the media coverage lacked any independent source of scientific evidence. We all know that real damage was done by the way in which that issue was handled in the media. Since the science media centre has been in place, the quality of public debate has been much better. I refer hon. Members to the House's recent discussions of the Human Fertilisation and Embryology Bill, where the level of public and scientific understanding displayed was much higher. Therefore, I think that over a period of time a lot has been done by Government to improve things.

Madeleine Moon: One of the ways that we have attempted to build public confidence in scientific research has been through the development of partnership with the business community. As we are facing an economic turndown, one of the areas that we must protect is that research; we must ensure that our companies are at the cutting edge of technology. What is my right hon. Friend's Department going to do to ensure that companies do not see saving on investment in research and development as one of the ways to save money, so that we keep our companies and our country at the cutting edge?

John Denham: My hon. Friend makes an important point. In "Innovation Nation", the White Paper we published in the spring, we recognised the importance of Government procurement in creating the markets for innovative products and services. We will shortly publish the first annual innovation report, and Departments are currently actively working on their procurement planning and on identifying how they will create a demand for innovative products. We have also revamped the small business research initiative, and Departments are now starting to offer new contracts to small start-up businesses for developing innovative technologies. One of the ways we can respond, therefore, is by making sure that Government procurement money is used in ways that reward research and encourage people to bring new products to market.

Adam Afriyie: We were surprised to learn from  The Guardian last Monday that, after 50 years of consistent Government policy in space research, the new Science Minister in the other place, who had been appointed on the previous working day, made a hasty multi-billion pound pledge to send UK astronauts into space. Does the Secretary of State agree with this policy U-turn, or is the new Science Minister speaking out of turn?

John Denham: I am delighted to have Lord Drayson as a member of my team. His record both in business and in science as a Minister is outstanding. He made it clear in his interviews that his personal view, which he had expressed prior to being a Minister, was that we should join a manned space programme. The position of the Government, which he supports and understands, is that we have a review of— [Interruption.] We are currently setting out a review, and we established it for a good reason. Twenty years ago, Baroness Thatcher took the decision that this country should not participate in manned space flight. I have to say that I think that decision has stood the test of time, because while we were not participating in that programme we have become a world leader in satellite technology, robot-exploring devices and so forth. In the future, we will have to look at the issue of whether the opportunities that would come from participating in manned space flight now outweigh the other opportunities and costs of investment in other research areas. It is right that, 20 years on, we approach this with fresh minds, but there are no predetermined decisions.

Apprenticeships

Simon Hughes: What progress has been made towards meeting the Government's apprenticeship targets.

Si�n Simon: The 2007-08 apprenticeships performance indicator of 75,000 framework completions has been met and exceeded early. with 112,000 people successfully completing an apprenticeship framework in 2006-07. Apprenticeship completion rates reached an all-time high in 2006-07 of 63 per cent. compared with 24 per cent. in 2001-02and an effective rate of zero under the Tories. Apprenticeship starts have increased from 65,000 in 1996-97 to 184,000 in 2006-07. Expanding apprenticeships will play a key role in improving the nation's skills base, and we plan to deliver more than 250,000 apprenticeship starts and 190,000 successful completions by 2020.

Simon Hughes: I welcome the Minister to his new job, and I wish him well in what is a very important responsibility. Following on from what was said on Questions 1 and 2, may I tell the Minister that many of the young people, and their families, in Southwark and Bermondsey would far rather they did apprenticeships than stay on at school to 16, let alone to 18? It is therefore important that we have good opportunities for work experience related to apprenticeships, and then good careers advice linked to real companies who are willing to take these young people on, if they are qualified to do the job. Can the Minister give me some assurance that there is a realnot a notionalopportunity for youngsters in construction and other industries who are clear about what they would like to do, but at present find it difficult to get the encouragement through their teenage years?

Si�n Simon: I am very grateful to the hon. Gentleman for his gracious words of welcome. I had expected a few such words from my old friend from South Holland and The Deepings, who was in fact just mean to me before I even had a chance to stand up and reply, but I shall soldier on. The hon. Gentleman makes a very good point, of which the Government are cognisant. We have introduced junior apprenticeships to try to take the whole concept of apprenticeships down into school so as to introduce schoolchildren gently to the notion of what an apprenticeship is and how it works, and to put them on the pathway to one. A whole new framework of careers advice and guidance will be part of the new Bill that we hope will be forthcoming in the next few months.
	I have looked up the figures and noted that the number of apprenticeship starts in the hon. Gentleman's constituency is quite low compared with the national figure. If he would like to come to talk to me about that at any point, I would be more than glad.

Jim Devine: I too welcome my hon. Friend to his new post, and I certainly do not see him as a novice.
	There are disproportionately more apprentices in England and Wales than in Scotland. Does my hon. Friend have any advice for the Scottish Government about how to rectify that unacceptable situation?

Si�n Simon: I am very grateful to my hon. Friend for his kind words of welcome. Indeed, if I am a novice, it is overnight success after seven and a half years on the Back Benches.
	As for Scotland, far be it from me to advise the Scots, but if I were a Scot I would support John Park's proposed apprenticeship Bill in the Scottish Parliament. I would consider issues such as why apprentices get paid 40 in Scotland compared with 95 in England, and why the Scots have put all the apprenticeship budget into three sectors and abandoned the rest. I would be looking for answers to those questions in the Labour MSP John Park's Bill.

Patrick Cormack: I congratulate the Minister on his promotion and on his new sartorial elegance, and I wish him every success in his important task. Does he agree that there is no more richly rewarding career than that of craftsman or craftswoman? We owe an enormous amount to the craftsmen of the past in the country. What are we doing to encourage young people to embrace a career in the crafts?

Si�n Simon: We have now reached a situation in which everyone is being nice to me, and I am very grateful for yet another hon. Gentleman's kind and gracious words of welcome. I can say only that my sartorial efforts, such as they are, like the hon. Gentleman's are not so much a new fad as antique.
	The bulk of my answer is the same as it was to the hon. Member for North Southwark and Bermondsey (Simon Hughes). The hon. Member for South Staffordshire (Sir Patrick Cormack) is absolutely right to say that learning craft skills from an early age is a way to encourage and develop a sense of the value of learning a craft, and of building or making something. That starts in schools and, more than ever in the context of a massively expanded, high-quality apprenticeship programme, there are junior apprenticeships in school. Young people are doing, in old-fashioned terms, woodwork and metalwork and really getting a love for the materials and the craft.

Celia Barlow: What steps he is taking to increase the number of people successfully completing apprenticeship schemes.

Si�n Simon: The number of adults and young people completing apprenticeships has almost trebled since 2001. The Government's document World-class Apprenticeships confirmed our commitment to making apprenticeships a high-quality option for both young people and adults and set out steps to increase the numbers of people successfully completing an apprenticeship.
	In the summer we published the draft Apprenticeships Bill to drive and help sustain improvements in the quality of the programme. That will be complemented by an increase in apprenticeships funding to more than 1 billion by 2010-11. Expanding apprenticeships will play a key role in improving the nation's skills base and we plan to deliver more than 250,000 apprenticeship starts and 190,000 completions by 2020.

Celia Barlow: I welcome my hon. Friend to his new post, and I welcome the news of the increase in apprenticeships and completions. However, particularly in the hospitality and catering trade, some apprentices leave because of maltreatment by employers. My constituent Rosario Guarneri, in conjunction with City college Brighton, has developed a ground-breaking apprenticeship scheme that will, hopefully, address those issues and others. Will the Minister or a member of his team meet my constituent to discuss the matter?

Si�n Simon: I thank my hon. Friend for her kind personal words. The short answer to the end of her question is yes. The relevant Minister is the noble Lord Young, who I know is aware of this matter. He has agreed to meet the sector skills council, and has said he is very happy to meet her and her constituent. This sector is important: there are 14,500 starts made in the catering sector every year. In an apprenticeship, any mistreatment of employees by employers is unacceptable, and our new blueprint makes it very clear that a relationship of mutual respect between both parties is key. I am sure that Lord Young will do everything he can to ensure that this situation is rectified. My hon. Friend is a great champion of these matters and of her constituents, as we all know

Anne McIntosh: I add my congratulations to the Under-Secretary of State for Innovation, Universities and Skills, the hon. Member for Birmingham, Erdington (Mr. Simon). I also congratulate the Minister of State, Department for Innovation, Universities and Skills, the hon. Member for Tottenham (Mr. Lammy), on his elevationwe can say that he now truly is PC.
	My concern is that, in the present economic climate, the number of completed apprenticeships will fall, because fewer apprenticeships will be offered. Can the Under-Secretary give the House the figures on those who, having completed apprenticeships, are offered full-time, permanent jobs?

Si�n Simon: I am grateful to the hon. Lady for her kind words of welcome. I think that the hon. Member for South Holland and The Deepings (Mr. Hayes) might be wishing he had been a little more gracious in the beginning.
	Obviously, in economically straitened times there are pressures on this sector, just as there are everywhere. One of the things that we have done is to introduce, in the particularly pressed construction sector, a construction industry clearing house for apprenticeship places, so that as people are laid off, we can try to re-find such places for them. I do not have the specific figures on the placements that the hon. Lady wants, but I shall certainly write to her with them.

Jeff Ennis: Is the Minister aware that Sheffield Forgemasters in south Yorkshire employs 70 apprentices, which is almost 10 per cent. of its total work force, and that the company has a record of taking on more than 90 per cent. of the apprentices who qualify? Does he agree that companies such as Sheffield Forgemasters are providing a best practice model for some of the bigger employers in the country in taking on apprentices?

Si�n Simon: I agree that Sheffield Forgemasters is an exemplary company. I know that my hon. Friend who is now Minister of State for Higher Education and Intellectual Property visited it when he was Skills Minister and was extraordinarily impressed by the outstanding work that he saw. I am thus happy to say from the Dispatch Box that the rest of the country should be looking to Sheffield Forgemasters for an example of how to do this brilliantly.

Anne Moffat: I am not going to be kind, because I expect Ministers to do a job. I want rights for apprentices who are working on building sites in England, because the way they are being treated is absolutely abominable. They are having to make themselves bogus self-employed. The situation is absolutely crazySin, sort it.

Si�n Simon: I am grateful to my hon. Friend. I must say that it is not actually my job to sort it but that of Lord Young, and he will do so. As a former apprentice and a former senior trade union official with decades of experience, he is more than well qualified to sort it. My hon. Friend may know that we have set up a review involving the construction industry, the construction industry unions and the sector skills council. All the stakeholders are holding a review to examine exactly these kinds of issues and everything else that has an impact on the construction industry and apprenticeships at this difficult time. My answer is the same as it was to my hon. Friend the Member for Hove (Ms Barlow): any mistreatment, of any kind, including through low wages, needs to be dealt with, and is unacceptable.

Physics and Astronomy

Michael Fabricant: What the Government's policy is on the future of physics and astronomy teaching in universities.

David Lammy: Physics has been designated as a strategically important subject and we have asked the Higher Education Funding Council to work with others to increase and sustain both the demand for and supply of physics graduates. We are pleased that the number of physics and astronomy students has increased.

Michael Fabricant: I know that the Minister will disagree, as I do, with those who say that it is engineers who create the wealth and that the scientists just spend it. We need the science to get the engineering going. In that respect, does the Minister believe we will see more science and innovation campuses, or will the current science funding settlement prevent that from happening?

David Lammy: The hon. Gentleman will know that there is a planned increase of 17 per cent. in our science budget over the next three years. Fantastic world-class science is being carried out across the country, and that is against a backdrop of increases in every subject in the number of students studying science at A-level. That is something to applaud and celebrate, as we can look forward to an increase in science and, as a consequence, in engineering in coming years.

Robert Wilson: I add my congratulations to both Ministers and wish them well in their new posts.
	The future of physics and astronomy teaching in universities could be affected by the substantial problems with Icelandic and other offshore deposits. Will the Minister update the House on that potentially serious blow to our universities? In particular, 77 million has already been identified, but is the Minister aware of any further at-risk offshore deposits?

David Lammy: This is obviously a serious issue, but to put it in context I can say that the HEFC advises that front-line services and services to students will not be affected. We understand that 12 universities have placed money on deposit with Icelandic banks, and the total amount involved is 77 million. The hon. Gentleman will appreciate that discussions are being held between the Treasury and Iceland on these matters.

Topical Questions

Jim Cunningham: If he will make a statement on his departmental responsibilities.

John Denham: In these difficult economic times, we must obviously take every possible measure to assist those who may lose or worry about losing their jobs. One of the most effective things that we can do is enable them to refresh or update their skills, or to retrain. Yesterday, together with my right hon. Friend the Secretary of State for Work and Pensions, I announced that we are making significant new money100 millionavailable over the next three years to support retraining and the development of new skills, so that people can move quickly back into employment.
	In addition to the role that Jobcentre Plus personal advisers play in offering advice and support, I will take two further measures to ensure that advice and support on skills is available. First, learndirect will be able to offer one-to-one advice on careers, skills and retraining, and I will take further measures to promote that service. Secondly, I will work with further education colleges to ensure that they make every effort to offer appropriate advice on and support for skills training to those who may worry about losing their jobs. I will announce further measures in due course.

Jim Cunningham: I thank my right hon. Friend for that answer and, given the present economic climate, I am sure he appreciates the contribution that the west midlands makes to the British economy. More importantly, is he aware of the contribution made through research and development by the university of Coventry and the university of Warwick? They make a major contribution to the economy through innovation and research.

John Denham: My hon. Friend is absolutely right to draw attention to the important role played by universities in many different ways. The university of Warwick is one of the leading research-intensive universities, with much national and international research, and the university of Coventry has a powerful role to play in the local and regional economy. It is important that the role of both types of university is properly recognised in our higher education and innovation system.

David Willetts: May I press the Secretary of State on university applications? We recognise and welcome the increase in university applications for this year, but is the Secretary of State concerned about the sharp drop in UCAS applications so far for 2009? Will he confirm that at this time last year 196,000 applications had been received, while this year applications are down by more than 50,000, at 139,000? What explanation can the Minister offer the House for that dramatic 30 per cent. fall?

John Denham: The hon. Gentleman will know that the figures that might be available at this time of year are figures from very early in the application process. There is always significant variation over the months. I do not see any reason to believe that the progress we have made on admissions and acceptances in recent years will not continue.
	I worry about the policy put forward recently by the hon. Gentleman's colleague on the Front Bench, the hon. Member for Reading, East (Mr. Wilson), which seemed to suggest a return to the Conservative policy of encouraging unfunded university expansion on a larger scale. That had disastrous effects on funding for students in the 1990s and I urge the Opposition not to pursue that policy.

David Willetts: We want to see more children with the A-levels that will enable them to go to university. May I press the Secretary of State further on the leaked UCAS document, which I have in front of me? It shows that applications to university are down very dramatically at this stage. They have gone down by 30 per cent. compared with this time last year. Does the Secretary of State not recognise that that is potentially an alarming development? It was a pity that he was so complacent in dismissing that important evidence. I invite the Secretary of State to write to me with an update on the figures for applications so far and an explanation of why he believes a 30 per cent. fall is not something that he regards as a worrying trend.

John Denham: We will report publicly in the proper way, as we do every year when the UCAS figures come in. There is a regular cycle of reporting and we will report on those figures. I want to see a continuation of progress in university numbers in years to come, and I believe that our policies will lead to that. We will start in the fairly near future with the launch of the student finance campaign, which emphasises the benefits of the financial support that we have extended, having reintroduced grants since they were abolished under the Conservative Government. I believe that we will make the progress that the hon. Gentleman wants to see. A leaked document at a very early stage in the process is not a point from which to draw too many firm conclusions.

David Taylor: Staff and students at local colleges have contacted me about the call of the Campaigning Alliance for Lifelong Learning to restore the 1.5 million adult education course places lost by the further education sector and the communities that it serves since 2006. What do the Government plan to do about those lost places for local people and their FE colleges, given the clear social and economic benefits of adult education, in terms of universal access to basic skills, social inclusion and personal development?

Si�n Simon: I am grateful to my hon. Friend for that question. I have come across the CALL campaign. It is clearly well meaning, but I think that it is misconceived. The overall investment in further education has increased massively and the only thing that has changed is the way in which the places are structured. We have moved towards a smaller number of higher-quality places with more of an impact on skills and employability. Simply to count numbers of places rather than thinking about the quality of learning does not make sense.

Mark Harper: Is it not the case that the university statistics show that most young people from our state schools who get the top grades are already going to our top universities? If we want to make sure that children from state schools are better represented at those top universities, is it not the case that we should fix the quality of schooling that they receive so that they get those top grades rather than beating up on top universities and their admissions procedures?

John Denham: Nobody has been beating up on top universities. However, of course I responded when the chancellor of Oxford university launched an attack on Government policy and pretended that we were trying to turn the university into a social security office, because that is wrong. We want to make sure that schools identify and nurture talent and enable people to apply to the university that is right for them.
	Any of our universities can be the right one for the right student. In the past year alone, more than 80 universities have become involved in academies and trust projects, because structural links between universities and schools are critically important. Many universities, though, recognise that they can do more, and just a couple of weeks ago nine of the most selective universities in this country told me that they wanted to find ways to guarantee that young people from schools that traditionally do not send children to selective universities have the chance to show what they can do. That will mean actively seeking out the best-performing students in some of those schools and offering them the chance to go on summer school exposure courses at the universities.
	The answer is that we need all those measures: universities should look at their admissions procedures, but we also need to strengthen what is happening in some schools. I do not agree with those who want to rule out any of those options or say that it is either/or.

Mr. Speaker: May I remind the House that, with topical questions, I am looking for brief replies and short and sharp questions?

David Kidney: Having slept on the forceful arguments made by my hon. Friend the Member for Sunderland, South (Mr. Mullin) in last night's Adjournment debate, will Ministers offer support for innovative research at universities? Sunderland university was mentioned last night, but I should like to add the university of Staffordshire, which has a campus in my constituency of Stafford. They make a great contribution to knowledge and wealth locally, regionally and nationally, so will Ministers favour the suggestion that 10 per cent. of the university research budget should go on specialist research of national significance?

John Denham: I recognise the valuable research role played by many universities but I have doubts about the 10 per cent. levy idea, as it would have to operate irrespective of the quality of the research. This country has a number of universities in the top 10 for researchin the league tables of which we take no noticebecause of the concentration of research investment. We want to support universities of the sort that my hon. Friend refers to, but we need to be careful not to undo things that are working well at the moment.

Tony Baldry: The downturn in the housing industry means that some construction apprentices on my patch have lost their jobs. That is obviously a tragic waste of training, but the loss of their work placement also means that they are no longer able to continue their studies at their further education college. That is another waste of training, and I was wondering whether the Secretary of State could talk to the FE sector about safeguarding at least the FE element of apprenticeships. Could he also talk to the relevant skills council about setting up a brokerage system for transferring apprentices who have lost their jobs to employers who might be willing to take them on? In that way, the training that has already taken place would not be lost.

John Denham: We set up a clearing house in August with precisely that purpose. To date, 400 young people have either been found new work placements with employers or been enabled to continue at college. I shall contact the hon. Gentleman to tell him how the system is operating, as it is designed to do precisely what he is quite rightly urging.

Joan Humble: The Secretary of State is aware that discussions are taking place about the role of the expansion of higher education as a key driver in the regeneration of Blackpool. Will he therefore continue his discussions with colleagues in other Departments to ensure that that expansion takes place, as Blackpool needs the new students to boost both its economy and its skills base and to take the task force reports further?

David Lammy: My hon. Friend continues to champion the new university in Blackpool and sets it in the important context of regeneration in the area. I am pleased that the Department has been able to make some money available through the HEFC. I do know that the discussions to which she refers are continuing, and that they involve our colleagues in the Department for Children, Schools and Families.

Stephen Williams: I welcome the Secretary of State's new ministerial colleagues to their positions. I look forward to constructive dialogue with them during the remainder of the Parliament.
	In these difficult economic circumstances, employers will undoubtedly be seeking to trim their costs. Does the Secretary of State agree that one false economy would be to cut employer investment in education and training? What will the Government do to make it easier for employees to study part time, especially in higher education?

John Denham: The hon. Gentleman will know that last year we made funding available through the HEFC for many thousands of co-funded part-time places. The number of courses has now exceeded the number that we planned for because the demand from universities has been so strong. So there is a real interest in universities and in business in funding part-time degrees on a new basis. That and other measures will help to sustain the investment that the hon. Gentleman rightly says is needed.

David Heath: Total student debt in this country is now about 22 billion. The average real student debt is about 33,000 after a three-year degree. One third of all students who have ever taken out a loan have not yet reached the threshold for repaying it. In the context of the current economic crisis and the fact that almost inevitably graduate unemployment will go up, what assessment has the Secretary of State made of the future of those figures, and what contingencies does he have in place?

John Denham: I remind the hon. Gentleman of two things. These are not like bank debts; they are income-contingent so if students do not achieve a level of earnings, they do not pay anything back. Secondly, the figures that he quotes take no account of the two-year time lag before the information gets on to the data system. More important, although people may start below the threshold for repayment in their first year of employment, typically the increase in earnings in the next two or three years is 37 per cent. So people do get jobs that repay the value of the degree for which they have studied.
	I have noted that, although the hon. Gentleman and many of his colleagues fought the last election on a policy of opposing university fees, we have now been told by the Front-Bench spokesman that that policy is to be changed. So I

Mr. Speaker: Order.

Andy Reed: While Loughborough university is rightly recognised for its sporting excellenceI congratulate many of those who are at Loughborough in the parade todaydoes the Minister recognise that Loughborough is at the heart of the energy technology institutes? This will bring jobs to the UK but also meet many of the demands that we shall hear later in the climate change statement. Will he ensure that the private-public sector partnership, which will spend more than 1 billion on research in this area is not lost in the current climate, in which research and development may be one of the first things that the private sector cuts? It is absolutely vital not just for the country but for Loughborough.

David Lammy: My hon. Friend is right. It is vital for the country; it will give us far more evidence on the benefits of energy renewables and help us to tackle climate change over the coming years. I congratulate Loughborough on being awarded the contracts. My hon. Friend should be reassured that that work will continue in the coming years.

Andrew MacKay: To return to the vexed problem of university deposits in Icelandic banks, can the Secretary of State answer two quick questions? What financial advice did his Department give to universities on their investments? Will he place in the Library a list of other dodgy offshore investments so that we can see the extent of the problem?

John Denham: I will write to the right hon. Gentleman. I would be surprised if my Department had given any advice to universities on where to invest their money. Universities are autonomous bodies responsible for the management of their own affairs, including their investment policies. Nor is it for me as Secretary of State to produce a personal list of investments I would not like to put my money into; I think that that would cause something of a stir that would be unnecessary.

Philip Hollobone: Will the Secretary of State reconsider his approach to quality-related research funding? Although it is right that the most excellent research should receive a disproportionate share of that funding, surely a far more equitable distribution is possible so that institutions such as the university of Northampton benefit from the seedcorn investment.

John Denham: It seems to me that the distribution of funding has to be determined by the quality of the research. The allocation system has changed to some extent to make sure that good research is not captured, but I am resistant to the idea of a simple, arbitrary, top-slicing of the distribution. The strength of our university system is built on rewarding quality, and I would hate to see that principle changed. That does not mean that we are not interested in how we support those universities that make a key contribution to their local and regional economy through different types of research and innovation activities.

Business of the House

Theresa May: Will the Leader of the House give us the forthcoming business?

Harriet Harman: The business for next week will be as follows:
	Monday 20 OctoberSecond Reading of the Political Parties and Elections Bill.
	Tuesday 21 OctoberOpposition day (19th allotted day). There will be a debate entitled Controls on Immigration followed by a debate on the Olympic legacy. Both debates will arise on an Opposition motion.
	Wednesday 22 OctoberRemaining stages of the Human Fertilisation and Embryology Bill [Lords].
	Thursday 23 OctoberTopical debate: subject to be announced, followed by motion to take note of the outstanding reports of the Public Accounts Committee to which the Government have replied. Details will be given in the  Official Report.
	The provisional business for the week commencing 27 October will include:
	Monday 27 OctoberRemaining stages of the Local Transport Bill [Lords].
	Tuesday 28 OctoberRemaining stages of the Climate Change Bill [Lords].
	Wednesday 29 OctoberOpposition Day (11th allotted day) (Second Part). There will be a debate on an Opposition motion, subject to be announced; followed by the Chairman of Ways and Means will name opposed private business for consideration.
	Thursday 30 OctoberTopical debate: subject to be announced, followed by a general debate on defence policy.
	 The information is as follows:
	 That this House takes note of the 5th, the 8th, the 14th to the 29th, the 31st to the 35th, the 37th, the 38th, the 42nd and the 50th Reports and the 1st and 2nd Special Reports of the Committee of Public Accounts of Sessions 2007-08, and of the Treasury Minutes on these Reports (Cm 7366 and 7453).
	I inform the House that the Commons calendar from December 2008 until October 2009 is available in the Vote Office.

Theresa May: I thank the Leader of the House for giving us the business for next week, which includes the debate on Wednesday on the remaining stages of the Human Fertilisation and Embryology Bill. There are reports today that the Prime Minister and the right hon. and learned Lady have fallen out over the amount of time that should be allowed for that debate. Will she confirm that she will make every effort to ensure that there are no statements that day, and that there will indeed be a full debate on the remaining stages of the Bill?
	The Leader of the House referred to the debate in the following week on defence policy. On 13 October, the Prime Minister of Iraq stated that he wants British troops to withdraw. May we have a statement from the Defence Secretary, before that debate, on whether that changes the Government's strategy in Iraq?
	I raised the matter of annuities with the Leader of the House last week and yesterday my right hon. Friend the Member for Richmond, Yorks (Mr. Hague) pressed her on it again, but neither of us got a satisfactory answer. Given that thousands of pensioners are being forced to buy an annuity that locks them into a lower income for the rest of their lives, the need to address the issue is urgent. Will the Secretary of State for Work and Pensions make an urgent statement to the House on whether the Government will adopt our proposal to suspend the rule on annuities?
	In July, I asked for a statement from the Chancellor on the ombudsman's report on Equitable Life. Yesterday, the right hon. and learned Lady ignored two questions on Equitable Life. The ombudsman has clearly stated that the Government must take some responsibility for the failures in Equitable Life and should be compensating policyholders, so may we have an urgent statement from the Chancellor apologising for the Government's failures and setting out the compensation scheme for policyholders?
	On Monday, the Home Secretary took the unprecedented step of interrupting House business and making a statement about the Government's defeat in the House of Lords on the issue of 42 days' pre-charge detention. Why was the statement not made on the following day in the usual way, thus giving Members proper notice, or was it that the Government wanted to give the statement when fewer Members were in the Chamber to question the Home Secretary? Can the Leader of the House confirm that this sets a new precedent and that in future Ministers will always make an immediate statement to the House whenever the Government are defeated in the House of Lords?
	In the past year the Government have lost the personal details of 25 million men, women and children from Her Majesty's Revenue and Customs, 45,000 people from the Department for Work and Pensions, 3 million learner drivers from the Driver and Vehicle Licensing Agency, 84,000 prisoners from the Home Office and over 2 million people from the Ministry of Defence, but yesterday the Home Secretary announced plans for a massive increase in the Government's ability to access people's personal data. What reassurance can the Home Secretary give that the Government will protect the integrity of any new data? Given the huge data losses so far, would it not be easier for the Home Secretary to make a statement listing the people whose data have not been lost by this Government?
	Finally, the previous Secretary of State for Business, Enterprise and Regulatory Reform was also the Government's anti-corruption champion. Can the Leader of the House confirm that the Prime Minister has found it necessary to remove that responsibility from Lord Mandelson of Foy and Hartlepool, and will she explain why? While the Prime Minister is looking at the noble Lord's responsibilities, will he also be removing his Department's work on regulating mortgages?

Harriet Harman: On the Human Fertilisation and Embryology Bill, there is no truth in the report that the right hon. Lady mentioned. She asked me to make every effort to ensure that no statement is made on the day the House debates the Bill. As I said this time last week, the House has had a great deal of time, rightly, to discuss this important and controversial Bill. It has been debated for a total of 81 hours on the Floors of both Houses, with 10 sessions in the Lords and, so far, seven in the Commons, and I hope that here will be a further full day of debate. I will seek to ensure that there is no statement that day. Obviously, I will need the flexibility to allow a statement for an urgent reason, but just as it is our intention to avoid making statements on Opposition days, we will try to ensure that we do not have a statement on the day we debate the Bill.
	On defence, as the right hon. Lady acknowledged, there is to be a general debate on defence on Thursday week, in which the issues can be fully explored.
	The right hon. Lady raised the question of those who need to buy annuities because they are approaching their 75th birthday. I have nothing to add to what I told the House yesterday. As I said then, this issue does affect some people; it is only a small number of people, but it does affect a number of people [Interruption.] That is not what I said. I said that it is only a small number of people, but it is an issue of concern and it is being considered.
	The right hon. Lady asked about the ombudsman's report on Equitable Life. On 8 October, the Chancellor repeated what he had said in the summer, after the ombudsman's report was published: this was an extensive and important report, and that he would make a statement on the Government's response in the autumn. That remains the case.

Theresa May: But it is the autumn.

Harriet Harman: Indeed. The right hon. Lady is absolutely rightit is the autumn.

Theresa May: So where is the statement?

Harriet Harman: Autumn has not finished yet.
	The right hon. Lady asked about the Counter-Terrorism Bill and the Home Secretary's statement to the House after the defeat of the 42-day provision in the House of Lords. Our view was that it was important for the House to hear the Government's intention as soon as possible, following the defeat of the clause in the House of Lords. If we had waited until the next day, speculation would have run overnight and there would have been a great many speculative news reports; but we thought that the House would need to hear as soon as possible, and therefore the statement was brought before the House. In fact, many Members of the House were present when the Home Secretary made the statement; the Chamber was packed, and it was an extensive statement.
	The right hon. Lady mentioned the communications data Bill, which the Home Office proposed and was included in the draft legislative programme. As she will know, instead of simply announcing the Bills for the legislative programme in the Queen's Speech, we have given the public an opportunity to see the Government's intentions by publishing the draft legislative programme in early summer, enabling people to comment before the Queen's Speech clarifies the Government's fixed intention for the legislative programme. The draft communications data Bill was in the draft legislative programme, and a number of issues and concerns have been raised about it.
	The Home Secretary has made it clear that at all times on important issues such as these, she wants to listen to people's concerns, consider them and consult on a wide, bipartisan basis. She has said that instead of pressing forward with legislation in the next Session, she will seek to consult further, including publishing draft clauses or possibly even a draft Bill. The right hon. Member for Maidenhead (Mrs. May) misunderstands the position: having published the measure in the draft legislative programme, we will undertake further consultation before we introduce the Bill in the House. It sounds as though she would probably welcome that, now that I have had an opportunity to explain the position.
	The right hon. Lady talked about anti-corruption. Anti-corruption responsibility runs across a number of Government Departments. At one stage in the past, the lead responsibility was with the Department for International Development; at another stage, it was with the Department for Business, Enterprise and Regulatory Reform. It is currently with the Ministry of Justice, but the point is that all Government Departments need to focus on the issue, and indeed they do so. The question of where the lead is is less important; more important is the fact that across government the agenda is delivered, and it certainly will be.

Joan Ryan: Will my right hon. and learned Friend make time available for a full debate in the Chamber on the unfolding catastrophe in Sri Lanka? We had a short debate earlier this week in Westminster Hall, for which I thank Mr. Speaker, but the situation is so serious, with the compulsory withdrawal of aid agencies from the Vanni region and the continued indiscriminate bombing of innocent Tamils, that a number of Members wish to speak on the issue. We need to hear a fuller response from GovernmentI acknowledge the extra aid that the Government have made availableso a full debate in the Chamber would be appropriate.

Harriet Harman: I will take my right hon. Friend's proposal as a suggestion for a topical debate. I considered the forward business as she made that point, and I cannot see an immediate opportunity, as the business stands, for hon. Members to raise the important issue that she brings to the House's attention, so I will consider it for a topical debate and think further on it.

Simon Hughes: May I endorse the request from the right hon. Member for Enfield, North (Joan Ryan), as there was a very large attendance in Westminster Hall, and I am sure that there would be interest across the House among Members from all parties in a substantive debate? Ministers have always been accommodating if the time has been provided.
	May I return to matters raised by the right hon. Member for Maidenhead (Mrs. May), which are of huge significance in relation to Home Office business this week? First, to go back to Monday night, it was unacceptable that an important debate in Government time on democracy and human rights around the world was interrupted by the making of a statement in the middle of it. Why could the statement not have been made at 10 o'clock, as is traditionally the case if an urgent statement is made? We could have had the full debate as planned, and the statement, and everyone would have been alerted in the normal way.  [ Interruption. ] It was indeed about news management, as it was hoped it would be covered by the financial discussions being conducted on Monday, which, as we know, was a difficult but important day financially.
	Out of the hat on Monday night the Home Secretary produced the rabbit, the temporary provisions Bill, as her fig leaf to cover her major U-turn. If she is serious about another Bill in the wings, may we have proper pre-legislative scrutiny of it, with the opportunity to take evidence on whether it is needed? We have a provision whereby Special Standing Committees consider a Bill and take evidence. Given the widespread opposition to the Billopposition that is massive in the House of Lords, significant in this place and very large in the countrythe justification for it has not been made out, and we need to have the debate before the Home Secretary has the Bill ready to introduce.
	On the other home affairs matter properly raised by the right hon. Member for Maidenhead, I have read the Home Secretary's speech from yesterday, including her references to the communications data Bill and I understand the exchange that has just taken place, but to some of us, on the back of the DNA database, the plan for ID cards and the proposal for 42-day detention without charge, the idea of an Orwellian super-database adds the final nail in the coffin, turning us from a people of liberty to a people of suspectsa completely unacceptable proposal.
	May we have a debate, therefore, in this place so that we can hear the Home Secretary, the proposal and the representations that she has received and see whether there is any public support for the idea that every phone call we ever make and its location, for example, is kept for the rest of our lives on some great Government system? The Government do not appear to be able to hold the data that they already have, let alone any more.
	Tomorrow, we will debate private Members' Bills: there are 51 on the Order Paper. The Government have always wanted to be helpful and the job of the Leader of the House is to be helpful to private Members. The right hon. and learned Lady may know that in the past six years nine out of 10 Government Bills have received Royal Assent. She may also know that only about one in 10 private Members' Bills have received Royal Assent. Will she seriously consider ways of giving better opportunity for private Members on her own side and others to get their proposals into legislation, and not hog all the time for Government business?
	We look for an assurance today that there will be no Government guillotine or timetable on the Human Fertilisation and Embryology Bill that prevents debate on related fertilisation, embryology or abortion if colleagues on either side wish to raise them. May we have an assurance not only that we will have a full day, but that the Government will not seek to manage the business to prevent that debate?
	Lastly, we will have a welcome debate next week on the Olympic legacy and building on the Olympic achievement. I invite the Leader of the House to join me and, I am sure, the right hon. Member for Maidenhead, on the day when the nation celebrates our fantastic Olympic achievement, in saying that we are hugely proud of our athletes in both games and many of us are greatly excited by the prospect not only of the games in London in four years' time, but of even better success then.

Harriet Harman: The Deputy Leader of the House and I will consider what the hon. Gentleman said about private Members' Bills and see whether we can make more progress.
	I take note of the fact that the hon. Gentleman backed up the point made by my right hon. Friend the Member for Enfield, North (Joan Ryan) about Sri Lanka, and I shall consider that as a request for a topical debate.
	Like the shadow Leader of the House, the hon. Member for North Southwark and Bermondsey (Simon Hughes) raised the topic of the statement on 42 days. We wanted to ensure that the House was told first and at the earliest possible opportunity.  [Interruption.] I see that the Opposition are now arguing that the statement should have been delayed until 10 o'clock. There are pros and cons to each timing. The most important aspect is the question of substance and the fact that the House was told expeditiously.
	The hon. Gentleman asked about pre-legislative scrutiny of the temporary provisions Bill, which is a matter for the Home Affairs Committee. If it wants to conduct pre-legislative scrutiny of the provisions and how they would be introduced and what effect they would have, that is a matter for the Committee. Of course, it carried out extensive pre-legislative scrutiny of the 42-day clause in the Counter-Terrorism Bill and took evidence on that.
	With reference to the communications data Bill, I cannot say more than what I said to the shadow Leader of the House. There will be further time for consultation. There will be publication, probably of draft clauses, if not of the whole draft Bill. There will be an opportunity for people to look at the objectives that the Bill seeks to achieve and whether the measures appropriately protect personal data and human rights. With all these measures, it should be recognised that as well as protecting personal privacy and confidentiality and human rights, it is important that we are able to help the police investigate and detect crime. The hon. Gentleman complains about the DNA database, but I remember the rape offenders who were brought to justice because DNA data were held on a database.

David Anderson: There have been welcome noises from the Government this week about helping people at work to maintain their jobs. May we have a statement from the Treasury about the decision by Her Majesty's Revenue and Customs to attack seafarers and mariners under the seafarers' earnings deduction, which will leave my constituent, Mr. Penny, facing a future in which, he says, the ruling has
	devastated my family life to the verge of collapse, bankruptcy is looming and the only alternative for many UK based mariners will be to leave the Industry or live outside of the UK?
	The decision can be reversed so that people can remain in the industry and not be 25 per cent. worse off in their salaries.

Harriet Harman: I will raise the matter with Treasury Ministers and ask them to write to my hon. Friend and deal with the point he raises.

Hugo Swire: The Leader of the House will be aware of the continuing press reports surrounding the relationship between the Secretary of State for Business when he was EU Trade Commissioner and Mr. Oleg Deripaska, who I understand is banned from the United States following an FBI inquiry into his business activities. Given the very serious nature of some of the allegations, may we have a debate next week to try to ascertain the nature of that relationship when the Business Secretary was EU Trade Commissioner, in relation to the ownership dispute within the Russian insurance company Ingosstrakh and the aluminium tariffs situation in Russia?

Harriet Harman: I do not think that business questions and the privilege that attaches to them should be used by hon. Members to make unjustified smears and allegations.

Lynne Jones: Will my right hon. and learned Friend confirm that, in line with usual procedure, when the House considers the Human Fertilisation and Embryology Bill on Wednesday, new clause 1 will be considered first?

Harriet Harman: In the debate on the Human Fertilisation and Embryology Bill the clauses, new clauses and amendments will be considered in the normal way.

John Bercow: May we please have a statement next week on the intended publication date for the delayed child health strategy and an indication of an early parliamentary opportunity to debate its contents? Given that early intervention and integrated commissioning between health, education and social services are vital to achieving better health outcomes for children, will the right hon. and learned Lady recognise that this important strategy needs to be published sooner rather than later, with explicit and funded commitments to meet the very high expectations that rightly now exist?

Harriet Harman: The hon. Gentleman rightly draws attention to an important strand of work. As to the timing of the publication of the health strategy for children, I will make inquiries to see whether I can be more specific and inform either him or the House.

Barry Gardiner: My right hon. and learned Friend will be aware from her constituency both of the considerable distress that is often caused when family members, particularly those coming from the subcontinent, are unable to obtain visas or are refused entry clearance into this country and, therefore, of the importance of the representations that Members of Parliament can make on their behalf. She will also be aware that the realignment of the UK Border Agency and UK visa services has led to a considerable delay and, I understand, a change in how Members' representations have been treated, so that it is now quite normal to experience delays of six to eight weeks. Will she investigate the matter and ensure that something is done, so that our constituents are not exposed to further distress?

Harriet Harman: There has been a considerable speeding up of responses to hon. Members in respect of their constituents in recent years. I will certainly look into the point that my hon. Friend raises and invite the Minister with responsibility for immigration to write to him and to place a copy in the Library so that it is available for all Members.

Evan Harris: May I take the Leader of the House back to the Human Fertilisation and Embryology Bill? In line with convention, Back Benchers in all parts of the House and on both sides of the argument have tabled important amendments to the Abortion Act 1967, for debate on the Bill on Report next Wednesday, giving the chance to debate the 1967 Act for only the second time in 40 years. If the new clauses are selected by you, Mr. Speaker, they will fall in the first group. Can the Leader of the House give us an assurance that there will not be a Government business motion relegating that group of amendments to a point where there will not be protected time, which would be most unfortunate and undemocratic given the free vote on those matters, and an assurance that they will be reached?

Harriet Harman: The hon. Gentleman will know that we have already had a whole day's debate on the question of abortion amendments that were raised on the Floor of the House in the summer. When we come back to the House I will seek to protect the time by doing my best to ensure that there are no statements on that day. The Bill will be debated according to the procedures in the normal way.

Chris Mullin: Will my right hon. and learned Friend find time, preferably before the autumn statement, to debate the impact of the imposition of the business rate on empty business and commercial property, which is potentially devastating in regeneration areas such as the one that I represent? Indeed, factories and businesses in Sunderland are already demolishing premises rather than pay the tax. The Pallion Engineering company, which is based in an old shipyard in Sunderland, faces an increase from 55,000 to 277,000 in a single leap, which will of course put it out of business and mean that the 200 people working there will lose their jobs.

Harriet Harman: There is particular concern about business in this difficult economic climate. I will draw the points that my hon. Friend makes to the attention of my right hon. Friend the Secretary of State for Communities and Local Government and my right hon. Friends in the Treasury, who will no doubt take them seriously.

George Young: Does the right hon. and learned Lady still plan to proceed with her wholly misguided policy of setting up a range of regional Select Committees? If she does, will she publish the relevant Standing Orders way in advance of any debate?

Harriet Harman: Yes, we are planning to proceed with what the right hon. Gentleman regards as the wholly misguided proposal to set up regional Select Committees. We will publish the Standing Orders in advance, on the basis of his request, so that he and other hon. Members will have an opportunity to scrutinise them in detail. Let me also take this opportunity to inform the House that the Regional Ministers are being brought together today in the Council of Regional Ministers to discuss the economic impact, region by region, of the current economic crisis. When the regional Select Committees are established, they will be able to hold that sort of activity to account better in the House.

Keith Vaz: The Leader of the House will recall that on 5 July 1991, the Bank of Credit and Commerce International was closed. Thousands of people were put out of work and depositors, including the Western Isles in Scotland and Channel 4, lost their money. They were told at that stage that they would not get their money back. Some 84 per cent. of depositors have got their money back, but the liquidation has now been ongoing for 17 years. Could we have a statement from the Government or a debate about what is now the longest insolvency in this country's history, so that it can be brought to an end as swiftly as possible?

Harriet Harman: I will ask my right hon. Friend the Chancellor to consider whether the best way to convey the information to my right hon. Friend and other Members who are concerned about the matter is to issue a written ministerial statement or to write to him.

Nigel Dodds: Can we have a debate on fuel pricing in this country? Although there has been a welcome reduction in the petrol and diesel prices charged at the pumps in recent days, many motorists and households remain concerned about the extra costs imposed through the heavy levies of duty on fuel. They are also concerned about the practice of many retailers of operating a differential pricing policy depending on geographical location, so that the same retailer can charge different prices to motorists depending on where they live. That is clearly unfair and discriminatory, particularly to my constituents in Northern Ireland. I would therefore be grateful if we could have a debate to discuss those issues.

Harriet Harman: At the end of this business statement there will be an oral statement on the subject of energy from the Department for Energy and Climate Change, immediately after which there will be a topical debate on the subject of energy providers, so the hon. Gentleman should have two opportunities to make that point.

Michael Clapham: May I draw my right hon. and learned Friend's attention to early-day motion 2254, which stands in my name?
	 [ That this House calls on the Department for Work and Pensions to accept the recommendation of the Industrial Injuries Advisory Council, whose report it has been considering since August 2008, and declare A14 Osteoarthritis of the Knee a prescribed disease in relation to coalmining with an early implementation date, opening the way for this group of mostly elderly sufferers to claim an award of industrial injuries benefit. ]
	The motion requests a decision from the Department for Work and Pensions in response to the Industrial Injuries Advisory Council's recommendation that osteoarthritis of the knee should be a prescribed disease in relation to coal miners. Will she urge the Department, which has had the IIAC report since August, to make an early decision, because the group of miners affected are quite elderly?

Harriet Harman: My hon. Friend has an exceptional track record of prompting Government to act swiftly on such matters. I therefore take his point seriously. He is absolutely right: time is not on the side of people who are suffering from such industrial injuries and diseases. I will get on to the Department for Work and Pensions.

David Drew: Now that the Government have dealt with the issue of toxic assets, is it not about time that we also looked into the issue of the toxic media? Much of the information in the leaks and scoops on our television screens and in our newspapers seems to be helpful to some, but immensely damaging to many of our constituents. Is it not about time that we had a proper look at how such information is obtained and reported?

Harriet Harman: I am sure that the Treasury Committee, on behalf of the House, will look at all such issues. As my hon. Friend says, it is very important indeed that when public information is given the economic situation is not made worse.

Norman Lamb: May I raise with the Leader of the House the serious allegations of match fixing and the unusual betting patterns that apparently took place in Asia in relation to the championship match between Norwich City and Derby on 4 October? I am sure that she would agree that such allegations attack the very integrity of sport in this country and must be treated with the utmost seriousness. May we have a statement from the Secretary of State for Culture, Media and Sport so that we can establish what contact there has been between him and the Football Association and so that we can see what stage the investigation has reached and ensure that it is given the priority that it deserves?

Harriet Harman: I will draw the hon. Gentleman's points to the attention of the Secretary of State for Culture, Media and Sport and ask my right hon. Friend to write to him.

Jim Sheridan: May I ask my right hon. and learned Friend whether we can have a review of the effectiveness of topical questions? My understanding was that they were supposed to allow Back Benchers in particular to raise questions of importance to them and their constituents. However, there is clear evidence that the spirit and intent of topical questions is now being abused by Front Benchers, who are using them for their own needs. Does she agree that if Opposition Front Benchers want to ask questions, they should go to the Back Benches and take their chances like the rest of us, and also that Government Front-Bench responses should be a bit shorter?

Harriet Harman: I think that topical questions have been an important innovation. The House will remember that they were introduced for one Session only, so that they could be reviewed at the end of it. The Standing Orders pertaining to topical questions will lapse at the end of this Session, allowing us an opportunity to review them. I think that, by and large, the House has found them very useful in ensuring that the subjects raised at Question Time are more topical. There is also the issue of whether there is sufficient time for Back Benchers, compared with Opposition Front Benchers. Obviously, that is a matter for the Speaker as well as for Opposition Front Benchers.

Andrew MacKay: Will the Leader of the House ensure that the Chancellor of the Exchequer comes to the House next week to make a statement on the behaviour of the nationalised bank, Northern Rock? This would give many Members an opportunity to query why the bank has passed on only one tenth of the reduction in interest rates to its savers, and why some of my constituents have been told by Northern Rock that, when their fixed mortgages come to an end, those mortgages will not continue, because that is what the Government have told the bank to do. That is unacceptable behaviour at a very difficult time. As Northern Rock has been nationalised, it is now the responsibility of the Chancellor of the Exchequer, and he should answer these questions.

Harriet Harman: The right hon. Gentleman knows very well, because the Chancellor has explained it to the House, that there is arm's length management of Northern Rock. The arrangements for Northern Rock, and what it has been told by the Government, are a matter of public record on which the House has been informed. The right hon. Gentleman knows that individual decisions on lending are made on an application-by-application basis and are not a matter for the Chancellor of the Exchequer.

David Taylor: Last weekend, a female constituent of mine went to an Oasis concert Birmingham's national indoor arena. When she returned to where she had left her car, she found that it had been towed away and that she faced a bill of 300. There were no signs to indicate that there were any problems. She was left isolated, vulnerable and stranded in that city. May we have a debate on how we could better regulate these unscrupulous and unspeakable clampers and towers who wreak such havoc on decent people through the activities that they perpetrate? We really cannot have the angst and inconvenience that my constituent experienced last weekend replicated time and again in cities all over the country on frequent occasions.

Harriet Harman: My hon. Friend raises an important point. Whether it is a question of people towing away cars or clamping them, we need to ensure that there are clear and fair rules and reputable operators. Real problems can be caused by cowboys taking liberties in this respect. This matter crosses a number of Departments, including the Department for Communities and Local Government and the Department for Transport, as well as the Treasury. I will give some thought to the point that my hon. Friend has made and see how we can take this matter forward.

Bob Neill: Yesterday, the Minister for Local Government informed the House of the situation relating to local authorities exposed to the failure of Icelandic banks. In particular, he was able to tell us that some 13 authorities might have short-term difficulties and that the Department for Communities and Local Government was sending a response team of experts into three of them. Last night, the leader of one of those three authorities, which the Minister had felt unable to nameTamworth borough councilissued a statement saying:
	Tamworth...is not in any immediate financial difficulty and its budgets will remain unchanged. There is no threat to services...I am shocked at hearing an emergency team is being sent to us. We neither asked for nor need one.
	Against that background, will the Leader of the House ask a Minister from that Department to come urgently to the House to clarify exactly what is the basis of the Government's intervention with these local authorities, on what criteria they were selected, which are the local authorities concerned, and which other institutions, such as regional development associations and housing associations, might also be affected? Drip-feeding only causes speculation, and the suggestion that the Government might be seeking to move attention away from themselves to the councils.

Harriet Harman: Ministers in the Department for Communities and Local Government have given information to the House during the course of the debate. There has also been a written ministerial statement. Response teams, which are the joint responsibility of the Department and the Local Government Association, will be sent to the authorities that request help. They will not be sent to those authorities that do not do so. I am sure that all the constituents of Tamworth will be reassured that their funds are safe.

Mark Harper: It is two and a half years since the House had the opportunity to debate in Government time the Government's policies for disabled people. I raised this matter with the right hon. and learned Lady on 1 May, and she very kindly said that she would consider my request and see whether there was an opportunity to debate the matter in the House. Can she tell us, five and a half months later, whether she has been able to give any consideration to the matter and when the House might be able to have a debate on the Government's policies for disabled people?

Harriet Harman: Certainly I will consider that as a suggestion for a topical debate. I am sure that the hon. Gentleman will welcome and engage in the discussion on the Equality Bill, which seeks to give stronger rights and greater opportunities for people with disabilities.

Angus MacNeil: Recent weeks have shown the importance of regulation. May I partly echo the words of the hon. Member for Belfast, North (Mr. Dodds)? We must have a debate on fuel prices, but may we also have a debate on the contracts between fuel distributors and the oil companies and refineries? Can we look in particular at whether there is adequate funding for the Office of Fair Trading to investigate and regulate those contracts, some of which may be contributing to the slow fall in fuel prices at the pumps?

Harriet Harman: The hon. Gentleman will have an opportunity to ask those questions in respect of the oral statement and to contribute to the topical debate on energy later this afternoon.

Peter Bone: The Government are spending 16,000 for each and every taxpayer on bailing out and funding banks, based on an ill-thought-out and seriously flawed plan. This affects everyone in the country. Is not it extraordinary that we have had no full-day debate on a substantive motion on this matter? Is it not the duty of the Leader of the House to provide such a debate, so that she can test the opinion of Parliament?

Harriet Harman: The Prime Minister will make a statement next week, following the European Council. Economic issues will no doubt be at the heart of that. The Chancellor made a statement on Monday of this week. The Government have been concerned to ensure that information is being brought to the House, and that the House has an opportunity to hold the Government to account. On the hon. Gentleman's point about spending in respect of each taxpayer, he will know that the Government needed to act to stabilise the financial situation and that that was necessary action. He does not need to rely on my word for that. Perhaps he will take the word of the Nobel prize winner for economics, Paul Krugman, who said:
	Luckily for the world economy...Gordon Brown and his officials are making sense. And they may have shown us the way through this crisis...The British Government went straight to the heart of the problemand moved to address it with stunning speed.
	On protection for taxpayers, I should like to refer the hon. Gentleman to the words of Simon Wolfson, the chief executive of the high street store Next, who said that this was
	a very good plan and will probably make money for taxpayers.
	That certainly should not worry people. We undertake to keep the House informed.

Michael Moore: Next week, communities across the south of Scotland will learn the fate of their local post offices. Frankly, few people are holding their breath. Confidence in the network as a whole is at rock bottom because nobody knows the fate of the Post Office card account. There are rumours swirling around that it might be given to PayPoint or awarded jointly, each of which would undermine the network. Given the seriousness of the situation, will the Leader of the House urge her colleagues to make an announcement as early as possible, and allow a debate in the House on the matter?

Harriet Harman: As I have told the House on previous occasions, the contract for the Post Office card account is subject to the procurement processes, and when a decision is reached, I am sure that the House will be informed.

Michael Penning: For many years now, my constituents have been sending treats to our troops who are serving around the world on our behalf. Last week, they were dismayed to see press reports telling them not to send parcels to our troops, who are so bravely looking after us, and saying that only family members can send treats to the troops. May we have a statement from the relevant Minister to tell us why, in the 21st century, we cannot send parcels to our troops?

Harriet Harman: I am sure that the question of public and family support for our troops will be at the heart of the defence debate that I announced in my statement under forthcoming business.

Richard Younger-Ross: Can we have a statement on the impact of inflation on pensioners? In particular, can the Leader of the House confirm that the state pension rise next April will be at least as high as the 5 per cent. retail prices index rise announced on Monday?

Harriet Harman: There will be an uprating statement from the Department for Work and Pensions shortly. Pensions and benefits will be uprated in the normal way. I am sure that the hon. Gentleman will welcome the increase in winter fuel payments and the efforts to ensure that the decrease in wholesale energy costs are passed through to domestic consumers and households.

Tony Baldry: Can we have a debate next week on access to mortgages? I have been approached by mortgage brokers in Banbury who told me:
	Lenders have again put up their rates despite the Bank of England reducing rates last week. They have also reduced the loan to value ratios and we are seeing properties being dramatically down valued to such an extent that it is impossible for people to remortgage when their fixed rates end. We were under the impression that tax payers money being given to these banks was on condition that lenders...began lending at 2007 levels. This is not happening... the situation has worsened to such an extent that we are virtually unable to help any of our clients.
	If the mortgage market does not get going again, there is no hope for the housing market doing the same. May we have a debate some time soonhopefully next weekon access to mortgages?

Harriet Harman: The hon. Gentleman makes a very important point. If the Government are in a position next week to make further information available about access to mortgages, a statement will be made.

Alistair Carmichael: I declare an interest as a member of the national council of the Royal National Lifeboats Institution.
	May we have a statement or a short debate on Ofcom's proposals for changes to the charging regime for maritime radio users? Those proposed changes will see many voluntary organisations such as the RNLI paying massively increased fees. The Leader of the House must be aware that the RNLI is funded entirely by voluntary contributions and that it provides a crucial service. Frankly, the Government and Government bodies such as Ofcom should be grateful for the provision of those services rather than see them as a cash cow for more income.

Harriet Harman: I join the hon. Gentleman in paying tribute to the RNLI and I will raise his point with the relevant Ministers and ask them to write to him.

Mark Field: One of the very few things that I have in common politically with the Leader of the House is that we both represent inner London seats. She will be aware that, notionally, our local police force, the Metropolitan police, is run by the Home Secretary. In view of the tumultuous and turbulent events within that organisation during recent weeks, does the right hon. and learned Lady feel that it is time either for the Home Secretary to make a statement to the House or for us to have a debate in Government time on the future strategy for the Metropolitan police?

Harriet Harman: As the hon. Gentleman will know, the process is under way for the recruitment of a new Metropolitan Police Commissioner. Speaking for my own constituency, I pay tribute to the work that continues to be doneday in, day out; week in, week outby the Metropolitan police in all the boroughs of London.

David Heath: All through the recess, I wrote to many of my constituents who contacted me saying that I was absolutely sure that Ministers would want to make two statements within the first week or so of our returnone on the Government scheme for insulating homes, which will be of very little benefit to many of my constituents who have stone houses and no cavity walls, and a second one on the ombudsman's report on Equitable Life. We have not seen either of those statements yet. Earlier, the Leader of the House rather airily said something about autumn, but will she further define what part of autumn she has in mind and when she believes autumn finishes?

Harriet Harman: As far as Equitable Life is concerned, I have nothing to add to what the Chancellor told the House on 8 October. As far as insulation and energy conservation are concerned, the hon. Gentleman will see that the Ministers from the Department of Energy and Climate Change are in their places to make a statement and take part in a debate.

Mark Lancaster: Can we have a debate on the Government's pharmacy White Paper, and particularly the proposals to restrict some GP practices on dispensing prescription drugschanges that, if implemented, would result in my constituents in Hanslope having to travel some 10 miles just to collect their prescriptions? Is that really a sensible move for some of the most vulnerable people in our society?

Harriet Harman: In respect of pharmacy issues in the hon. Gentleman's constituency, I suggest that he should either write to the relevant Secretary of State or seek a meeting.

Philip Hollobone: Can we have a debate in Government time on parental neglect and binge drinking among schoolchildren? Last year, 250 people were so incapacitated from being drunk that they were admitted to Kettering general hospital, and one fifth of them were children under the age of 16.

Harriet Harman: We have had a topical debate on excessive drinking, particularly by under-aged children. The hon. Gentleman will know that work is going on across Departments on this issue, which is of concern throughout the country. I will consider how best to find an opportunity for the House to debate it further.

David Burrowes: Can we have a debate on issues arising from the extradition of my constituent Gary McKinnon, confirmed this week by the Home Secretary? The Leader of the House will recall the debate regarding the NatWest three, when the Government gave assurances that they would take steps to seek bail. Can at least similar efforts be made on behalf of my constituent, who is a vulnerable young man of little means who was, significantly, recently diagnosed with Asperger's syndrome?

Harriet Harman: The best thing would probably be for me to discuss the issue with the hon. Gentleman after business questions, so that he can tell me the details of the case. I can then work out how to assist him further and raise the matter with the relevant Department. I always call the NatWest three the Enron three.

Philip Davies: Can I reiterate the call of many hon. Members for an early statement on Equitable Life? If the Leader of the House continues her unacceptable stonewalling on the subject, can I ask her for a debate on the role of the parliamentary ombudsman? It is unacceptable to many people that the Government can ride roughshod over the ombudsman's rulings.

Harriet Harman: The Government are not riding roughshod over the ombudsman's ruling. The ombudsman produced a substantial report, which required considerable reflection from the Government. We have kept the House updated on how we intend to deal with the matter. The Chancellor said last week that he intends to make a statement on our response to the ombudsman's Equitable Life report this autumn.

Department of Energy and Climate Change

Edward Miliband: With permission, I would like to make a statement on the new Department of Energy and Climate Change. The new Department brings together the Government's work on three long-term challenges that face our country: ensuring that we have energy that is affordable, secure, and sustainable; bringing about the transition to a low-carbon Britain; and achieving an international agreement on climate change at Copenhagen in December 2009. Those are our goals, and the new Department recognises that when two thirds of our emissions come from the use of energy, energy and climate change should not be considered separately, but together.
	Some people will ask whether we should retreat from our climate change objectives in tough economic times. In our view, it would be quite wrong to row back, and those who say that we should misunderstand the relationship between the economic and environmental tasks that we face. Of course, there are choices to be made, but there are also common solutions to bothfor example, energy-saving measures for households, such as those announced by my right hon. Friend the Prime Minister in September, which cut bills and emissions; or investment in new environmental industries, which both improves our energy security and reduces our dependence on polluting fuels. What we know from the Stern report of 2006 is that the costs of not acting on climate change are greater than the costs of acting on it. Only if Britain plays its part will a global deal in Copenhagen to cut carbon emissions be possible, so, far from retreating from our objectives, we should reaffirm our resolve.
	Over the summer, the Secretary of State for Environment, Food and Rural Affairs, to whom I pay tribute for his work and leadership on climate change, asked the independent Committee on Climate Change to review the long-term target for Britain's emissions. Based on a Royal Commission report in 2000, the target had been set at a 60 per cent. reduction in CO2 emissions. Since then, independent reports have added further to our knowledge. Arctic sea ice has melted faster than expected, global emissions have grown faster than expected and the impact of each degree of climate change is known to be worse than expected.
	Last week, Lord Turner wrote to me with the committee's conclusions, which have been placed in the Library of the House. His report found that to hold global warming to 2 above pre-industrial levelscommonly accepted as the threshold for the most dangerous changes in the climateglobal emissions must fall by between 50 and 60 per cent. by 2050. Lord Turner concluded that to play its proper part, the United Kingdom should cut its emissions not by 60 per cent. but by 80 per cent. He concluded that the target should apply not just to carbon dioxide but to all six Kyoto greenhouse gases. He also concluded that while there were uncertainties about how to allocate emissions from international flights and shipping, they too should play their part in reducing emissions.
	The Government accept all the recommendations of the Committee on Climate Change. We will amend the Climate Change Bill to cut greenhouse gas emissions by 80 per cent by 2050, a target that will be binding in law. I hope that Members on both sides of the House will support that move. Indeed, let me say that I want to create as much of a consensus as possible on climate change. However, as we all know, signing up to an 80 per cent. cut in 2050, when most of us will not be around, is the easy part; the hard part is meeting it, and meeting the milestones that will show we are on track. For us in Britain, the milestones will be shaped by the recommendations of the Committee on Climate Change, which will advise us in December on the first 15 years of carbon budgets. That means national limits to our total emissions, within which we shall have to live as a country. We will report next year on how we will meet them.
	We are also determined to ensure that the signal and the commitment come not just from Britain but, as the Prime Minister has been making clear in recent days, from Europe. That means an agreement by the end of this year on strengthening the European Union emissions trading scheme, and on the targets for 2020: that Europe should reduce greenhouse gases by 20 per cent. unilaterally and by 30 per cent. as part of a global dealtargets that I reaffirm todayand that the EU should confirm its renewable energy target.
	Earlier this year, we published our draft renewable energy strategy. Having examined the issue, I can say that what is clear to me is not only the scale of the challenge, but the urgency of getting on with the delivery. The renewables obligation has tripled supply in the past five years, and we are making further changes in its structure, in planning policy and in access to the grid. However, having heard the debate on the issue, including what has been said by many colleagues on both sides of the House, I also believe that complementing the renewables obligation for large-scale projects, guaranteed prices for small-scale electricity generationfeed-in tariffshave the potential to play an important role, as they do in other countries. Having listened to the views that have been expressed, including those expressed in the other place, we plan to table an amendment to the Energy Bill to make that happen.
	I believe that renewable power can play a bigger role not just in electricity but in heating. Heating produces almost half Britain's carbon emissions, and cleaner sources of heat can help us to meet our target in 2050 and the milestones on the way. I recognise that we need to make rapid progress on that issue as well, and I will make further announcements soon.
	Our objective is a climate change policy that is fair and an energy policy that is sustainable. The present structure of the energy market was designed in a world of abundant supply, British energy self-sufficiency, low commodity prices and an emerging debatebut not a settled consensuson the issue of climate change. Today, all those assumptions have changed. There is international competition for resources and a need for new investment in supply; there are structurally higher energy prices; and there is urgency about carbon emissions. To respond to this new world we need a market that secures future supply, which must include investment in nuclear power and carbon capture and storage. We need a market that provides incentives for cuts in emissions and does more to help homes and businesses.
	Those are the big issues that we need to address for the future, but today I want to signal a direction of travel on affordability. Last week the energy regulator, Ofgem, highlighted what it believed to be unjustified higher charges for 4 million electricity customers in areas not connected to the gas main. It also believes that, even when account is taken of higher costs facing companies from customers with pre-payment meters, many homes that use them are being overcharged.
	Unfair pricing that hits the most vulnerable hardest is completely unacceptable. I made that clear to the representatives of the big six energy companies when I met them yesterday. I also told them that the Government expect rapid action or explanation to remedy any abuses, and I will meet them again in a month to hear what they have done. We, and Ofgem, are determined to see those issues addressed. Ofgem is consulting on its findings until 1 December as part of a due process, but let me say this: if the companies do not act satisfactorily and speedily, we will consult on legislation to prevent unfair pricing differentials.
	For us, markets can provide enormous benefits in dynamism and efficiency, but they will only work properly if they are regulated effectively in the public interest, including with a strong independent regulator. There is more to be done to help consumers, and we will not hesitate to act. We need an end to unfair pricing, feed-in tariffs for electricity generation, and an 80 per cent. cut in emissions.
	Our aim is a climate change and energy policy which is fair and sustainable, and which meets our obligation to today's and future generations. That is the work that we are beginning in my new Department, and I commend my statement to the House.

Greg Clark: I warmly welcome the right hon. Gentleman's statement, and welcome him personallyalong with his ministerial colleaguesto the Front Bench. I also welcome him to the Dispatch Box, where he appears for the first time in his new post.
	The Secretary of State is widely regarded as one of the most personable, thoughtful and respected members of the Government. Our debates have always been civilised and productive, and it is certainly my intention that our exchanges on this most important issue for our country's future should remain so. I thank him for allowing early sight of his statementalthough not quite as early as that secured by  The Guardian and the Politics Home website, which published most of the statement this morning. I remind him that the true home of politics in this country is Parliament, and that it should have been through Parliament that the statement was first released. But, for all that, we welcome it.
	Conservative Members agree that the choice between ambitious and progressive action on carbon reduction and a successful, powerful economy is, in fact, not a choice at allthey are one and the same. Without decisive action, there is a risk that climate change will leach away huge resources from this country and every other nation on earth. The economic events of recent days have proved that catastrophic risk must be acted on rather than wished away. Does the Secretary of State acknowledge, however, that we start from a position of disadvantage? There has been a decade-long void in the Government's policy on energy, in which successive Ministers have looked the other way rather than addressing the issue of our future energy needs. Does the Secretary of State accept that to the intrinsic difficulties of making choices on energy have been added the consequences of a decade of indecision?
	It was Conservative Members who first called on the Government to publish the Climate Change Bill, which we have sought to strengthen through scrutiny in this and another place. We have been called here today for the Secretary of State to announce a new target, but does he share his predecessor's view that the Government are unlikely to meet their 2010 target of a 20 per cent. cut in emissions, despite three successive manifesto pledges? We support his acceptance of the Committee on Climate Change's target of 80 per cent.we have always said that we should be guided by the science on thatbut, as he knows, eight years ago 60 per cent. was considered to be the right target. Does he agree that the committee should keep the target under constant review, and that if the advice changes, so must the target?
	Does the Secretary of State share our view that the move to decarbonise our economy should involve leading the way in new technology and practices at home, rather than simply buying in permits from other countries? If he agrees with that, does he also agree that the Committee on Climate Change should advise on the right balance between domestic and traded reductions? Does he accept that his predecessors have been paying lip service to carbon capture and storage without decisive action? Will he commit himself to our policy of funding at least three CCS demonstration projects, so that Britain can lead the world in this vital technology?
	If the Secretary of State is serious about decarbonising our economy, will he give us a guarantee by adopting our emissions performance standard, whereby no plant will be licensed if its emissions are worse than those of a modern gas-powered station? Will he acknowledge that decentralised generation offers a vital way for our citizens to cut their fuel bills and emissions, and inject greater resilience into our energy supply? I welcome his belated acceptance of our case for feed-in tariffs for micro and small-scale generation; however, it is regrettable that his statement appeared to contain nothing about tariffs for renewable heat and gas. Will he also now recognise the case for smart metering, which will enable customers to profit from microgeneration? Finally, will he tell us how many vulnerable people he now expects to be in fuel poverty by 2010, the date by which the Government have committed themselves to eradicating it?
	Gas customers without pre-payment meters pay up to 40 per cent. more than those using online direct debits and, according to Ofgem, the cheapest online offers may be below costin other words, the poorest are subsidising the well-off. We look to the Secretary of State to act through his conversations with Ofgem and the companies, so that the poorest get the most help, not the least.
	We welcome the measures that the Secretary of State has proposed today but, as with our public finances and our financial system, on energy and climate change, we are hobbled byhow would his friend the Prime Minister put it?a decade of irresponsibility. Britain cannot afford the years ahead to be wasted like the years that have passed.

Edward Miliband: In the past few weeks, we have grown accustomed to the bipartisan consensus lasting all of 30 seconds before the Opposition retreat to their normal practice. I welcome the hon. Gentleman to his new role. I had the pleasure of having him shadow me at the Cabinet Office, where he distinguished himself with his talentand sometimes with his constructive suggestions. He made his name in the Conservative party through his admiration for Polly Toynbee, which I share. He went slightly further than me, however, because he was in the same party as her at one stagethe Social Democratic party. However, I welcome him to his new position and I am sure that he will fulfil the role with distinction.
	Let me deal with some of the specific questions that the hon. Gentleman raised. On the question of inaction and targets, let me say clearly that currently, on the latest figures, our greenhouse gas emissions are 16 per cent. below our 1990 levels. We have made progress. Indeed I think that we are one of the few countries to be going beyond our Kyoto targets. Therefore, far from a decade of inaction, we have been making progress.
	On the question of buying in permits, the Climate Change Committee will indeed advise us on that issue. I urge him, as someone who is new to these questions, to take care on that issue. It is right that we set stretching and demanding targets for our country, but it is also right that we find ways, because we are in this together, to encourage other countries to move to a low-carbon economy.

Greg Clark: Both.

Edward Miliband: Exactly. One of the ways of doing that is through carbon trading and buying in permits. He says that it should not be one or the other. That is the position that I am explaining.
	On the question of carbon capture and storage, the hon. Gentleman does what the Conservative party has started to do quite a lot, which is to say, Why don't you just fund more of this? Of course we want to do more in respect of carbon capture and storage. However, he may not have noticed that times are tight in terms of public expenditure. We are funding a carbon capture and storage demonstration competition. What is morethis is an important point and Conservative Members do not want to hear it, because it is about Europe and they do not like to hear about thatwe are arguing within the European Union for a dozen carbon capture and storage projects, which the European Parliament has agreed. In my early experience of this job, it has been quite good to go to European meetings and not to be seen as someone on the sidelines who is talking about withdrawing from the groupings that we are in or about renegotiating existing treaties. Being part of the European Union is about being a proper member of it.
	The hon. Gentleman asked a number of other questions. We agree that smart metering has an important role to play. We also agree on the issue of prices. I made it clear in my statement that we expect Ofgem to act as an independent regulator should, and put pressure on the situation in terms of prices across a range of areas, including on the issue of pre-payment metershe rightly pointed out that that is an issue.
	I look forward to my debates with the hon. Gentleman in the coming months, but on the issues of energy and climate change the Conservative party is completely confused. Nuclear power used to be a last resort. Now Conservative Members are not quite sure what their policy is. They say that they are in favour of renewable energy, but all around the country they oppose wind turbines, and they oppose tooth and nail the Planning Bill, which will make it possible for us to make a difference in relation to renewable energy. Therefore, I encourage him in his first few weeks in the job to sort out Conservative party policy on those issues.

Alan Whitehead: It is customary to start questions from the Labour Benches by congratulating the Minister on his statement. I do not know how it is possible to add to that, but I unbelievably warmly congratulate the Secretary of State on the statementthe Gordian knot on climate change and energy supply has been untied.
	On the proposals for a feed-in tariff for small-scale generators, is it the intention, either directly as a result of the feed-in tariff mechanism, or indirectly through an incentive mechanism, to ensure that heat is part of the process of small-scale generation tariffs as well as electricity?

Edward Miliband: I pay tribute to the work that my hon. Friend has done on these issues, particularly feed-in tariffs. He is one of the people who has led the work on those issues. I have looked at and listened to what he has been saying on those questions. I agree that heat can also play a role. We need to find ways of doing that. I look forward to talking to him about those issues. Again, we will want to make announcements very soon on that issue.

Steve Webb: I also warmly welcome and congratulate the right hon. Gentleman on this critical role within government. I also congratulate the Government on following the Lib Dem lead from nine months ago and putting energy and climate change into a single brief. However, I want the right hon. Gentleman to be even more powerful than he is because we will tackle climate change effectively only if he also has control over pretty much the rest of the Government as well. Is it not the case that, in the week that he was appointed, one of his ministerial colleagues said, We will expand Stansted airport? What is the point of having a climate change Minister who has no clout with the rest of the Cabinet? I urge the Secretary of State to wield a big stick around the rest of the Cabinet and ensure that not just energy and climate change decisions, but all other Government decisions are taken through a green lens.
	I welcome the move to the 80 per cent. target. Can I save the Secretary of State some trouble? He does not need to table a fresh amendment. He can simply accept mine: amendment No. 1 to the Climate Change Bill, which deletes 60 and inserts 80. It is on the Order Paper, and I will be honoured to have his name added to it.
	On a serious point, can the Secretary of State clarify the coverage of the 80 per cent. target? He used some vague words in his statement about aviation and shipping playing their part, but he did not say that they were included in the 80 per cent. target. Is not excluding aviation and shipping from the 80 per cent. target like being on a calorie-controlled diet but not counting the cream cakes that one plans to eat? Surely, we have to count the big polluters and the rapidly growing polluters in the target.
	On the issue of domestic effort, we fully appreciate the importance of saving emissions at home and abroad, but is it not the case that the Climate Change Bill would allow every single saving to be brought in? We do not have to save any domestic emissions at all under the Bill. Surely the Secretary of State, when he goes to international forums, wants to set the lead? Is there not some floor that he is willing to set that insists that the British domestic effort is substantial?
	The Secretary of State had a meeting with the energy companies yesterday, the latest in a very long line of cosy chats with them that have delivered precisely nothing. Is it not time, not for more cosy chats, but for action? His statement says that, if the energy companies do not play ball, he will threaten them with consultation on legislation. Have not hard-pressed customers had to wait long enough?
	Today, I have published figures that show that the poorest four fifths of single pensioners will on average be in fuel poverty this winter; the figures were produced by the House of Commons Library based on Office for National Statistics projections. That is totally unacceptable. Waiting another month and then consulting is too late for pensioners this winter. Will the Secretary of State act far more urgently than that?

Edward Miliband: I thank the hon. Gentleman for his kind words about my statement. It is probably a good sign that everyone is trying to claim credit for that on the Opposition Benchesperhaps that is better than the alternative.
	Let me deal with the specific questions that the hon. Gentleman has raised. The first was about Stansted airport and the announcement by my right hon. Friend the Secretary of State for Transport. One needs to be honest about the trade-offs and difficulties. If we carry on flying in the way that we are and expanding airports, we need to do less of other things. We are absolutely determinedthis is why I said thatto meet our overall targets.
	The hon. Gentleman raised the issue of the 80 per cent. target and whether it includes aviation and shipping. Lord Turner's advice is that they should be taken into account and be considered as part of the overall target. There are concerns, however, about including aviation and shipping in the Bill which relate to the measurement and calculation of international aviation, and the hon. Gentleman knows that there are ongoing discussions about how to calculate international aviationdomestic aviation is easier to deal with. However, it is, of course, the case that aviation and shipping need to be part of our overall approach to cutting carbon emissions. That is why, for example, we have argued that aviation should be part of the EU emissions trading scheme, which will be the case from 2013. The hon. Gentleman invited me to sign his amendment. I shall have a look at that and get back to him. However, I suggest that he does not call me; I will call him.
	On the important issue of energy prices and pensioners, I agree with the spirit of the hon. Gentleman's remarks about the urgency of getting on with things. I have been in this job for less than two weeks, and I am absolutely committed to moving as quickly as is legally possible on all these issues, as I have been making clear to officials in my Departmentand as I made clear yesterday to the big six energy companies, and as I have made clear in my two meetings so far with Ofgem, the independent regulator. We have a regulatory system in this country that we must observe, but I am absolutely determined that we will deal as speedily as possible with some of the issues the hon. Gentleman has raised.

Malcolm Wicks: I thank my right hon. Friend for making a clear, serious and radical statement, which encourages many of us, and I congratulate him and his formidable ministerial team as they take up their new responsibilities. They take them up at a time when the geopolitics of energy insecurity impinge not only on Europe's and Britain's supply, but on Britain's national security.
	May I ask two questions? Many of us believe that climate change is truly the big challenge facing our planet this century. Will my right hon. Friend confront the siren voices that we are now hearing in many parts of the world, including Europe and Britain, that say that, given the economic and financial difficulties, we cannot afford to save the planet? My right hon. Friend has stressed the economics of tackling this problem, and I wish him all strength in that campaign.
	My second question is on affordability. Despite the Government's many achievements in many Departments in safeguarding the interests of the most vulnerable, we know that many vulnerable people, and not just the elderly, are frightened about the prospects this coming winter. Will my right hon. Friend consider going further than the energy efficiency package that has been announced, and develop a kind of national planto use an old-fashioned termso that we can start to retrofit Britain's housing stock to help tackle the problem of carbon emissions while making sure that we understand our duty to protect our most vulnerable from the perils of the cold?

Edward Miliband: Let me start by paying tribute to my hon. Friend for the great work he has done on this issue. He started much of what was in my statement on the energy side. I know that people across the House and across the energy industry have the highest regard for the work he has done on these matters, and I look forward to carrying on working with him in his new role around global energy markets.
	On my hon. Friend's climate change question, I completely agree that we must confront the siren voices who say we should retreat and row back from these commitments, partly because we know that the longer we wait the worse the problem will get, and partly because, as I said in my statement, we know there are ways in which we can address both the economic issues we currently face and the long-term climate change questions.
	I also have a lot of sympathy with what my hon. Friend has said on the issues of fuel poverty and affordability, and I am urgently looking into that by asking what more can be done, as soon as possible, to help such vulnerable people. Let me make just one other point, however, which refers back to my statement. We have a market system that was designed 20 years ago in completely different times, and some of the issues that we are now facing are symptomatic of having a differently designed system created some time ago. Therefore, there is a whole set of questions that we need to consider to do with how we can fundamentally tackle the issues my hon. Friend raised in his second question.

Peter Luff: As Chairman of the Business, Enterprise and Regulatory Reform Committee, which has had responsibility for scrutinising energy policy, I must welcome the higher priority that is being given to energy and climate change matters, even as I regret what I imagine will be the loss of my Committee's responsibilities in this area, and also the loss of an excellent Minister of State, the hon. Member for Croydon, North (Malcolm Wicks), who will be greatly missed. I also worry that the new Department might have an inappropriate tension between energy and climate change, because there is a tension between those two matters; securing supply is also very important for keeping the lights on, and I did not hear quite enough on that in the Secretary of State's statement, although I am sure we will hear more about it later.
	Let me ask a question specifically on fuel poverty. The Secretary of State referred to pre-payment meters, but may I gently remind him that they are not the real issue? The real issue is standard credit terms. Most fuel poverty is concentrated among pensioners and others who are on standard credit terms, and that, for me, is the real political priority if we are to keep people warm this winter.

Edward Miliband: I thank the hon. Gentleman for his question, and I pay tribute to his Committee for its July report on these issues. I recommend it to Members as a good readalthough perhaps not a bedtime readas it addresses in great depth the issues surrounding the energy market and energy prices. It is an impressive piece of work, and I have found it extremely useful.
	I agree with the points the hon. Gentleman makes on security of supply being a very important issue. Of course, there are always dilemmas and tensions in Government, such as between energy and climate change, and we need to find ways of resolving them. The new Department can, however, also now take advantage of the synergies between those two issues.
	The hon. Gentleman asked about people on standard credit, and I agree that that is an issue. On pre-payment meters, however, let me just say to him that there is a conventional wisdom, which I do not say he shares, that many of the people on pre-payment meters are not disadvantaged people. The fact is that 53 per cent. of people on pre-payment meters are in the D and E socio-economic categories. Disproportionately, it is the poorest who are on such meters. Not everyone on a pre-payment meter is poor, but many of the poorest in our society are on one. That is, therefore, an urgent issue, and so, too, are the other matters that the hon. Gentleman has raised.

Tony Lloyd: I, too, welcome my right hon. Friend's bold statement. The 80 per cent. target will be widely welcomed not only in Britain, but throughout the world. In response to my hon. Friend the Member for Croydon, North (Malcolm Wicks), my right hon. Friend made the important remark that we need to look again at the whole structure of the energy markets. Will he give the guarantee, which I think is consistent with what he has said, that we will never allow price to be used as an instrument to ration energy supply to the poorest people in our country, because this issue is not only about security of supply, but it is also about adequacy of supply for people who need heat and light?

Edward Miliband: My hon. Friend is absolutely right, but we need to address the issues in a cautious manner because, as the hon. Member for Mid-Worcestershire (Peter Luff) has said, investment and security are also important matters, and we need to ensure that companies keep investing. In this area, there is a whole range of problematic issues across the board, which, again, the Select Committee addressed very well. As I pointed out to the energy companies, only 60 per cent. of the people who switch supplier do better from having done so, which means that 40 per cent. are either no better off or worse off from having switched. I made the point to the energy companies yesterday that that does not suggest to me that the market is working as well as it should in relation to the information people are receiving and what is happening with prices. Somebody said to me yesterday that a week after having switched suppliers the prices changed and they were worse off from having switched. Therefore, a whole range of issues need to be looked at; I thought it was better to look at them in detail with proper care and attention than to make statements about them in my first two weeks in the job, but they are important issues that need to be addressed.

David Heathcoat-Amory: Is the Secretary of State aware that earlier this week the Department for Transport brought forward new environmental regulations for the automotive industry where the Government's own impact assessment showed that the costs are likely to exceed the benefits, possibly by as much as 11 billion? Does that not show that there are better ways of reducing our carbon emissions, such as by the Government's new-found and recent conversion to nuclear power, and that it would be a sad and damaging outcome to his statement if we were to meet our UK emissions simply by driving businesses and jobs, and emissions, overseas without any benefit to the global environment, but at further great damage to British manufacturing industry, which is already in recession?

Edward Miliband: Two issues are raised by the right hon. Gentleman's question. The first is the efficiency with which we meet our targets and about which he makes an important point. Our overall target for climate change emissions and the EU emissions trading scheme play an important role, but the more extra targets we have below that, the more danger there is that we will meet those targets less efficiently. I did not refer to that when the Opposition Front-Bench spokesman asked me about the matter, but that would be my response to additional targets and limits in relation to specific power stations. The right hon. Gentleman raises an important point on that.
	The point on which I disagree with the right hon. Gentleman is that I think the European Union must play an important role. A lot of cross-border issues are involved, such as the EU emissions trading scheme, and they need to be dealt with in a cross-border fashion. We need a European dimension, partly for reasons of competitiveness. We also need to take care, when setting new targets, that we do not damage our competitiveness unnecessarily.

Elliot Morley: I welcome my right hon. Friend and his team to the new Department, which is an excellent step forward. It could not have had a better start than this statement, which addressed not only targets but issues such as the consumer impact. I welcome his comment that markets have changed in the past 20 years, and I wonder whether that logically means that the regulator's role should be reviewed to address those changes.
	As chairman of the all-party Globe UK group, I have written formally to my right hon. Friend, not only to welcome him to his new post but to offer our support as we move towards the crucial 2009 COP 15, and to express the importance of a post-Kyoto framework coming out of that conference. In that respect, does he share my concern that there are signs that some European member states are going backwards on mid-term targets because of the situation that we face? Does he agree that the European Union needs to set a clear example and send a signal if we are to get an agreement at COP 15?

Edward Miliband: Again, I pay tribute to my right hon. Friend's work, both in Government and as president of Globe, which is an important organisation that works with legislators across the world on climate change issues. His work will be an important part of our securing a deal in Copenhagen at the end of next year.
	On the wider questions of regulation that he raises, I shall proceed cautiously. It is important that we continue to get the investment that we need in the energy market, but I have come to no conclusions on the matter yet. The context has changed and, in the coming months, I shall examine the implications of that on policy.

Malcolm Bruce: May I make a plea for people in rural areas who have no option of gas and depend heavily on heating oil? According to the Library note, heating oil is 86 per cent. above its July 2008 price and 227 per cent. above the late 1998 and early 1999 low. Those people are really hurting, and they are not benefiting from falling prices as others are. What can the Secretary of State's Department do to ensure that they do?
	Secondly, the Secretary of State has not mentioned the security of our own oil and gas production, which will still be needed despite the climate change commitments. Can he reassure us that the Government have a commitment to maximising production from our own resources for our own security?

Edward Miliband: On the second point, absolutely. That is very important. I put it to the right hon. Gentleman that we are a transition economy, but it will be a long transition and the role of oil and gas will be central for many years to come. I absolutely agree with him about that.
	On rural areas, I shall examine the right hon. Gentleman's point about heating oil. He raises an important issue, because I believe that the 4 million electricity-only customers identified in the Ofgem report are mainly in rural areas. Part of the discrimination that Ofgem has found is against people in rural areas, who are paying more than they should be. I hope that the companies take action on that quickly to help ease some of the problems to which he refers.

Lynne Jones: I too welcome my right hon. Friend to his important new role in this very important new Department. I congratulate him also on the quality of his statement and particularly the decisions that it contained, such as the change of heart on the feed-in tariff, which I very much welcome.
	My right hon. Friend mentioned Stern. May I ask him to consider how we are progressing towards achieving Stern's recommendation that we should be spending 1 per cent. of gross domestic product on reducing and mitigating climate change? Of course, the feed-in tariff is an example of the Government using their powers to encourage private investment, and nobody is suggesting that all the money needs to come from Government sources. However, the information from the Library suggests that Government spending is only a fraction of what it needs to be if we are to meet the Stern recommendations. May I ask him to examine that? After all, having strong targets is no good if we do not have the means of achieving them.

Edward Miliband: My hon. Friend makes an important point. I think that the 1 to 2 per cent. recommended by Stern was for 2050, so we have some time to get there. I shall take that as a homework point to go away and examine. Working out the direction of travel for public spending and what will be required is an important part of the attempt to tackle climate change.

Several hon. Members: rose

Mr. Deputy Speaker: Order. I think that the time has come for a plea for brevity. I have to protect the important debates to follow, so I am aiming to move on to them by roughly 1.25 pm. I hope that I do not hear the word secondly again, and I am afraid that those who arrived late for the statement may be casualties.

Henry Bellingham: Will the Secretary of State find time to come up to Norfolk and join me on a flight over the Wash, where he will see a large number of offshore turbines? We will eventually have 500 or so. They are very popular, in stark contrast to onshore turbines, which generate very little electricity, are extremely unpopular and do great damage to the environment. In a case such as Norfolk and Suffolk, does he agree that turbines should be concentrated offshore?

Edward Miliband: I will be cautious about accepting the hon. Gentleman's invitation, not least because of the carbon emissions that would flow from flying over the wind farms. However, I agree that offshore wind plays an important role. Believe it or not, we are about to overtake Denmark in the amount of offshore wind power that we have, which is a good sign that we are moving in the right direction.

Barry Gardiner: My right hon. Friend's statement was dynamic and decisive, and it has given his Department the best possible start. In setting the 80 per cent. target, he has recognised that long-term certainty is vital for investment in energy. Will he consider ensuring that investment can be made in renewables, particularly wave technology and other marine technologies, and that incentives are aligned with the need for the technology?

Edward Miliband: Again, I pay tribute to my hon. Friend for his work on forestry and a range of other matters. I shall definitely consider wave technology, which has already been raised with me, and I am happy to have a meeting with him about it.

Robert Smith: In answer to my right hon. Friend the Member for Gordon (Malcolm Bruce), the Secretary of State mentioned the study of electricity prices. It is important that our constituents get a fair deal on electricity in rural areas, where there is no access to the gas main. He did not tackle the fundamental point that even a slightly cheaper electricity bill will not pay the oil bill. The cost of heating homes that do not have access to the gas main is disproportionate. If the Government seriously want to tackle poverty in rural areas, they will have to come up with a much more robust strategy for those who do not have access to the gas main.

Edward Miliband: The hon. Gentleman will forgive me; I do not have an immediate answer to that question. I shall endeavour to look into it now that it has been raised by both him and the right hon. Member for Gordon (Malcolm Bruce).

Mr. Deputy Speaker: I call Mr. David Winnick.

Nia Griffith: Thank you, Mr. Deputy Speaker. I certainly welcome

Mr. Deputy Speaker: Order. I called Mr. David Winnick.

David Winnick: I think that there is a differenceat least, I hope so.
	I welcome my right hon. Friend's statement, but will he accept that there is bound to be anxiety up and down the country at the increase of some 35 to 40 per cent. that is being implemented in domestic prices? Would it not be useful if, when he met the energy companies, he would be a little tougher and make it clear to them that those increases should be cancelled? If not, why not a windfall tax?

Edward Miliband: My hon. Friend has a long-standing interest in these matters. As he knows, a windfall tax is really a matter for the Chancellor of the Exchequer, not for me, but I would say to my hon. Friend that we are very concerned about what is happening to prices. The wholesale gas price is now going down, and we will be looking to see how that is passed on to consumers. We absolutely want that to happen.

Philip Hollobone: My constituents support renewable energy. We have a wind farm at Burton Wold with 10 turbines, soon to expand to 17 and possibly to 24 in future. It supplies between a quarter and a third of the houses in the borough of Kettering. What local residents do not want is loads more wind farms all over the countryside, but five planning applications are coming through. What mechanism exists for local authorities to support a wind farm in their locality without feeling pressurised into giving permission for all the applications that come along?

Edward Miliband: In the end, this is a matter for local decisions. We have taken action in the Planning Bill to speed things up, but this issue is not easy. I know, from the experience in my constituency, that people worry about the impact of wind farms on the value of their houses and so on. The problem is that, as always with these things, if we do not act on questions of renewable energythe hon. Member for North-West Norfolk (Mr. Bellingham) rightly made the point about offshore wind, but onshore wind must also play a partwe will not meet our renewable energy targets. There is no easy answer, but I think that feed-in tariffs and the possibility of community wind farms and smaller-scale projects have an opportunity to command more public consent than larger-scale projects sometimes do. That is another reason why I hope that the decision I have made about feed-in tariffs will help on some of these questions.

Nia Griffith: I apologise to you, Mr. Deputy Speaker, and to my hon. Friend the Member for Walsall, North (Mr. Winnick), for jumping in too early.
	In order to reduce our emissions by 80 per cent., we clearly need increased investment in a wide range of renewables. Will the Secretary of State carefully consider what the cumulative effect would be on forest and land use around the world of locating enough biomass material to feed all the biomass power stations in the planning system? I fear that our system of renewables obligation certificates might end up rewarding electricity producers for importing biomass materials huge distances from unsustainable sources. That would be completely different from small-scale projects using locally sourced biomass.

Edward Miliband: The question was definitely worth waiting for, because this is an important issue. My hon. Friend may know that an independent report on forestry published earlier this week argued precisely for a sustainable approach to forests, which must include the approach we take on biomass. I hear her comments and will think further about them.

David Heath: I welcome the statement, although I did not quite hear the detail about the insulation scheme that the Leader of the House advertised in advance. I am strongly in favour of that scheme, which is long overdue. The problem that I face is that many of my constituents are among the most vulnerable people, because of the reasons explained by my Liberal colleaguesthey are dependent on oil fuel or high-tariff electricity; and they live in houses that are often cold, damp and old, so they cannot benefit from cavity wall insulation. May I suggest to the Secretary of State that we need the maximum flexibility in the scheme so that the most appropriate measures are taken to reduce energy need, whatever that might be in a particular area and for a particular type of house?

Edward Miliband: I agree with the hon. Gentleman that we need as much diversity as possible, particularly in relation to the CERTcarbon emissions reduction targetscheme. One thing that I discussed with the companies was the diverse range of ways in which they can help people with their heating bills. It is right that we make and encourage the investments involved in this scheme, because that is a sustainable way to reduce people's bills. I know that there are issues to address, particularly in respect of older houses and the kind of technologies that we need to develop. We need to speed up such development and continue to examine it.

David Hamilton: I congratulate my right hon. Friend on his radical statement, which contains enough to give credence to everybody's point of view. I wish to make two points. First, security of energy is of the utmost importance, because, at the end of the day, we must deal with it. Secondly, clean coal technology must be part of that dimension. Some 85 per cent. of our reserves are still in this country, so it would be ludicrous if we did not deal with that. May I ask him to take one message back to the six companies? Can he tell him that if they do not change, Members on both sides of this House will change things for them?

Edward Miliband: I agree with my hon. Friend, because keeping the lights on is a central part of what we need to do and the security of supply is obviously central to that. He also makes a very important point about the future role that coal and carbon capture and storage can play. I concur with that, as a result of my local experiences.

Jamie Reed: My right hon. Friend rightly talked about the role of our European partners in creating an effective response to the environmental challenges that we face. Will he undertake to show the same effort with regard to the incoming United States Administration, to ensure that the international response is what it needs to be?

Edward Miliband: I thank my hon. Friend for that question. He raises a very important issue that will define whether we get an agreement at Copenhagen at the end of next year. I am very encouraged by what both candidates for the presidency have said about what they want to be doing on the environmental and climate change issues that we face, and the role that the US can play. Obviously, Britain, Europe and other countries have an important role to play after the US election in engaging in dialogue with our US partners about how they can be part of a successful process leading up to the Copenhagen meeting.

Hywel Williams: Plaid Cymru and the Scottish National party welcome the new target. It will be particularly welcome in Wales, where the One Wales coalition Government agreement already commits the Welsh Assembly Government to a 3 per cent. annual reduction in greenhouse gas emissions.
	On unfair pricing, I wish that the Government would move towards legislation quickly, because the energy companies' record is not good. Can the Secretary of State give an early indication of the nature of such legislation? Would it be UK-wide or would it cover England and Wales? Alternatively, would he take the option of having enabling clauses to allow other Welsh Assembly Governments to build on an already good basis? That would be of interest to Welsh consumers.

Edward Miliband: We need to examine the matter in more detail, but if we took legislative action to end unfair pricing in these areas, we would want to ensure, by talking to the Welsh Assembly Government and our counterparts in Scotland, that it was UK-wide. The situation may differ in different parts of the country, so I cannot prejudge that issue. Clearly, this is something that we would want to have across the country.

Michael Clapham: I welcome my right hon. Friend's statement and, indeed, the new team. When he met the energy companies last week, did he discuss phase 2 of the EU emissions trading scheme? As he knows, the energy companies will pick up a large sum, estimated by Ofgem to be 9 billion. Did he talk about how that might be used to deal with some of the problems that we have just discussed? Were the energy companies responsive to any of his suggestions?

Edward Miliband: The meeting that I had with the energy companies yesterday is becoming increasingly public. There is an awareness of the long-standing issue of the EU ETS and how the decision was made on carbon allowances, and of the EU ruling on that question. The companies would say that they are using that money for investment. It is also important that they realise that at this time, when people are under terrible financial pressure, they have a set of responsibilities to our wider society and to the people who are their customersI certainly made that point to them.

Tony Baldry: As someone who served on the Public Bill Committee on the Climate Change Bill, I very much welcome the Secretary of State's statement, although one thing puzzles me. If we are to meet the emission targets, surely power stations such as Kingsnorth will require effective carbon capture from day one, rather than at some unspecified date in the future.

Edward Miliband: I have not prejudgedit would be wrong for me to do soa decision about Kingsnorth, which, as the hon. Gentleman knows, is part of a process. I agree that carbon capture and storage is essential as a clean fuel of the future. It is the thing that makes fuels such as coal very important and part of our energy future. CCS must be central to our plans.

Anne Snelgrove: I thank my right hon. Friend for listening to the arguments of the Labour Back Benchers on the Public Bill Committee who originally tabled the remove 60 and replace with 80 amendment and making that replacement. Will he consider whether public sector buildings should be in the top quartile of energy efficiency so that we can achieve an 80 per cent. carbon emission cut by 2050?

Edward Miliband: I pay tribute to my hon. Friend's work and that of Labour Back Benchers on pushing this issue forward. She makes an important point about public sector buildings, because we need to do a lot more in that area. The Parliamentary Secretary, Cabinet Office, my hon. Friend the Member for West Bromwich, East (Mr. Watson) is working on these issues, and I intend to work with him to move forward what we are doing in this area, because the public sector must show a lead.

Roger Williams: One of the first reports to land on the new Secretary of State's desk will be on the viability and potential of the Severn barrage. A number of organisations are lining up against the barrage, including Friends of the Earth and the Royal Society for the Protection of Birds. Will he undertake to bear in mind, when considering that report, that other technologies could be equally productive in terms of energy, but much more friendly in terms of nature conservation?

Edward Miliband: Again, I hope that the hon. Gentleman will forgive me for being coy on such questions. I want to examine issues such as the Severn barrage properly, and I will certainly take account of the points that he raises.

Clive Betts: I very much welcome the commitment to the 80 per cent. target. It is an ambitious target, as my right hon. Friend will agree, that will require co-operation from all levels of government. Will he therefore have a word with the Secretary of State for Transport to try to persuade him to support an amendment that I have tabled to the Local Transport Bill that would require all local authorities to have regard to issues of climate change when formulating their transport policies?

Edward Miliband: I will definitely do that. My new Department has a wider role across government, working with the Departments for Transport and for Communities and Local Government and others, on such issues. We will not always succeed in our aims, but I accept that we have that responsibility. My hon. Friend also raises an important point about the role of local authorities and communities in being part of the battle to tackle climate change.

Phil Wilson: I welcome the dynamic statement that my right hon. Friend has made today. As he knows, the north-east of England is well placed to lead the way in offshore wind farms. What is his Department doing to prioritise offshore wind farms and what part will they play in reaching the 80 per cent. target?

Edward Miliband: Offshore wind does play an important part in our plans. In the Energy Bill, we are introducing a so-called banding system for the renewables obligation that will reward offshore wind, taking account of its higher costs with one and a half renewable obligation certificates rather than the standard one. That will incentivise people to build offshore wind capacity. We are apparently overtaking Denmark and I am told by my officials and the British Wind Energy Association that that is a big deal. However, I am sure that there is further to go on offshore wind.

Paul Flynn: May I urge my right hon. Friend to pursue his proposals on feed-in tariffs with vigour, because they will produce benefits quickly, and avoid being bewitched by the Pied Piper of nuclear power, which will not?

Edward Miliband: I will try to avoid being bewitched. I will also try to take a balanced approach to these issues. We need a diverse energy supply that includes nuclear as well as renewable energy and microgeneration.

Kerry McCarthy: My right hon. Friend has certainly hit the ground running in his new job, but he may not yet have realised that Bristol has ambitions to be the green capital of the UK. That is illustrated by the fact that nearly 1,000 people have written to me about the 80 per cent. target. To achieve that target, we need fundamental changes in our behaviour, as individuals, as companies and in the public sector. What is he doing to encourage people to adopt more sustainable lifestyles?

Edward Miliband: I thought that my hon. Friend was going to ask what I was doing to adopt a more sustainable lifestyle. I am certainly not putting myself forward as a paragon of virtue, because that would be very dangerous. The argument on the science of climate change has been won, but the argument about how people can make a difference has not yet been won, and we have a lot more to do. We have the Act on CO2 campaign which my hon. Friend the Under-Secretary led in her time at the Department for Environment, Food and Rural Affairs and will lead in the new Department. However, more can be done in local communities to show how they can lead the way in tackling climate change.

Celia Barlow: My constituents will greatly welcome the measures announced today, especially the 80 per cent. target, which I called for in February. However, many of my constituents live in houses in multiple occupation. What can be done to assist them not only with pre-payment meters, but to achieve the target and become more green, which is what they want?

Edward Miliband: My hon. Friend raises an important point, but it is one to which I do not have an immediate answer. How do we encourage landlords, especially private sector landlords, to play a role in relation to energy efficiency? More can be done on that and it is something that I am considering.

William Cash: In relation to carbon capture and storage, will the Secretary of State consider preparing plans to reopen the mines, for the reasons given by the hon. Member for Midlothian (Mr. Hamilton)? We would have to run both policies in parallel, and the training that would need to go with them. Does he also recall the Radio 4 programme about three weeks ago in which Sir David King and Dieter Helm severely condemned the wind turbine policy, in line with the arguments that we are making in Norton-in-Hales and Maer in my constituency?

Edward Miliband: I shall endeavour to obtain a transcript of the programme, although I do not agree with those views on the evils of wind turbines. I do agree that coal can play an important role in our future. As I have said, carbon capture and storage and the new technologies are an important aspect of making clean coal part of the energy mix of the future.

Phyllis Starkey: May I reiterate the importance of improving the energy efficiency of the existing housing stock and remind my right hon. Friend that on top of the problems of older houses and private landlords there is also the issue of housing of non-traditional construction, much of which is in the control of local authorities, and almost all of which is lived in by people on very low incomes? Those houses cannot be easily made energy efficient, but they must not be left out.

Edward Miliband: My hon. Friend speaks with a deep knowledge of these issues and I look forward to hearing her suggestions on what we should do in that area. She clearly raises an important point.

David Anderson: May I respectfully suggest to the Secretary of State that he does not take too much advice from the Conservatives who, after all, destroyed the cleanest coal technology in the world and put in place the companies who are fleecing our constituents? In discussions about clean coal technology, everyone talks about carbon capture and storage, but we should also consider the underground gasification of coal. Will he meet me and people from Newcastle university who lead the world in that?

Edward Miliband: I would be happy for our team to do that. CCS and IGCCas I think it is called, although I shall not try to remember what that stands for. It may be intergasification combined cycle, or integratedno, I should not have tried. In any case, all those technologies have an important role to play in the future.

Jim Devine: My constituents will welcome this statement and, in particular, the action that the Secretary of State is taking against energy companies. Has he considered similar action against the petrol companies? Petrol prices were $147 a barrel, and the price was rising almost every day, but it has now fallen. Apart from at Asda and Tesco, however, pump prices remain high, despite the fact that oil prices have almost halved.

Edward Miliband: The fundamental point that my hon. Friend makes is right. When prices go up and companies pass them on, the counterpart should be that when prices fall, the reduction needs to be passed on urgently and swiftly.

Mr. Deputy Speaker: I call Anne Moffat.

Anne Moffat: Oh you are a sweetheart, Mr. Deputy Speaker. I did not think that I was going to be called

Mr. Deputy Speaker: Order. I have been called many things, but that was a first.

Anne Moffat: I just love you today, Mr. Deputy Speaker.
	I congratulate the Secretary of State on his new job, but will he have the guts to tell the Scottish Executive that they cannot rule out nuclear power when it comes to security of supply?

Edward Miliband: I will not comment on how I regard you, Mr. Deputy Speaker, other than to say that I have the greatest of respect for you.
	My hon. Friend is right that nuclear power must be part of our energy mix. We were right to lift the moratorium on nuclear power, and I am sorry that the Opposition took a long time to come with us on that issue. I will certainly make that point to the Scottish Executive.

Fiona Mactaggart: Like everyone else, I welcome the statement, and I am especially looking forward to the letters that I shall write to those many constituents who have asked about a cut of 60 per cent. and feed-in tariffs. In his increasingly public meeting with the energy companies yesterday, did my right hon. Friend get a commitment from them that the very poorest people, who are on enforced pre-payment meters, will pay the lowest tariff?

Edward Miliband: It is fair to say that there is further to go with the energy companies on these issues. There are two questions, and we must be clear about them. First, the energy companies claimcurrently supported by Ofgemthat the cost to the companies for people with pre-payment meters are higher than for other people. I am urgently investigating that claim. The second issuealso raised by the Ofgem reportis that even taking account of those higher costs, people on prepayment meters are paying too much. On that point, I have demanded urgent action from the companies. On the first issue, I am investigating the truth of those claims and what can be done about the issue in general.

Mr. Deputy Speaker: I thank hon. Members and the Secretary of State for making reasonable progress. I hope that I have not prejudiced the chances of hon. Members who wish to speak in the other debates.

Topical Debate
	  
	Energy Providers

Mike O'Brien: I beg to move,
	That this House has considered the matter of energy providers.
	My right hon. Friend the Secretary of State for Energy and Climate Change has just told the House that our new Department aims to have a climate change policy that is fair for people and an energy policy that is fair for the planet. The issue is how we balance those things, and I want to set out how we intend to do so.
	I join other colleagues in paying tribute to my predecessor as energy Minister, my hon. Friend the Member for Croydon, North (Malcolm Wicks), who for three years provided leadership and a deep commitment to dealing with fuel poverty and ensuring energy security in this country. My right hon. Friend the Secretary of State and I look forward to working with him in his role as the Prime Minister's special representative.
	It is important that we reach a balanced view on climate change policy and energy policy. We must understand three key points. First, global circumstances shape our choices at home. Secondly, we must ensure that energy suppliers are encouraged to deliver affordable energy in sufficient quantity. Thirdly, we must be clear-eyed about the need for new energy generation in Britain.
	On the first point, we know that the global financial situation means that we all face serious times. Now, more than ever, climate change and the green agenda will face a testing time. There will be what my predecessor called siren voices, who will say that to deal with the financial problems we need to forget about the green agenda. The statement made today by my right hon. Friend the Secretary of State had not only an important practical objective but a symbolic importance. He clearly said that the Government will not be distracted, will maintain their focus and will ensure that climate change is at the forefront of the Government's agenda.
	The Stern report made it clear that the longer we wait to deal with the problem, the greater it will be and the higher will be the price to pay for not dealing with it. It is important that we focus on the issue in the coming years. However, these are serious times for people who have to pay billsfor companies, small businesses and individuals. In the first half of this year, average UK domestic electricity prices were the fifth lowest in the EU; average gas prices were the lowest. However, during the following months, price rises for households and companies followed substantial rises in international wholesale prices for crude oil, natural gas and coal. That, of course, fed into the increasing prices of electricity and the bills that people receive.
	International prices more than doubled between 2006 and early to mid-2008, principally because of rising global demand for fossil fuels, bottlenecks in freight and underinvestment in global production. Customers around the world are paying more for their energy and, even with a competitive UK supply market, our markets alone cannot entirely protect us from global pressures and competition for energy sources and resources.

Robert Smith: The Minister is right that we are now in a globally dependent market, but it is very important that we maximise production from our own market. Is he aware of the growing concern in north-east Scotland that although the big companiesI declare an interest as a shareholder in Shellhave enough cash to invest, much of the future production and investment in the North sea has been from smaller companies entering the market. The smaller companies rely on the capital markets, which are frozen at the moment. Will he ensure through PILOT that a strategy is in place to tackle the impact of the credit crunch on that vital investment in the next round of North sea exploration and production next year?

Mike O'Brien: The hon. Gentleman is quite right that we need to ensure that the credit crunch and problems in the financial markets do not prevent the long-term investments that we need in the North sea and off the coast of Scotland to ensure that we get the maximum benefit. There is still a lot of benefit to be obtained from the oil and gas that is still accessible. The need to ensure that some of the smaller companiesparticularly some of the American companies, but others, toocan access the more difficult-to-access resources is enormously important.
	Of course, with the credit crunch problems there are likely to be some issues with the accessibility of finance. We want to use PILOT, as the hon. Gentleman suggests, and work through some of the issues with the companies to see whether we can maintain as much of that financial long-term investment as possible.
	We must remember that that investment is long term and that many of the companies will already have sorted out some of the finance. They may well produce some problems as a result of what has happened in the past month or so. If we can work through some of those issues with them, and see whether we can get some recognition that there is a stable, long-term Government interest in ensuring that the investment happens, we can provide some element of reassurance. I cannot promise that we will solve all the problems, but we are certainly very alive to them.

Jim Devine: Does my hon. and learned Friend agree that although there might be sustainable oil, we should not base an economy on it, recognising the fluctuations that we have seen over the past five or six months?

Mike O'Brien: My hon. Friend knows that oil and gas is depleting, and although it still provides about two thirds of the oil and gas needed for our economy as a whole, it is depleting at a rate of about 10 per cent. a year. Basing a whole economy on that is obviously not the way forward. A diverse economic base is needed, and the Government have tried to encourage the diversity of that economic base. I only wish that we had a level of co-operation from the Government in Scotland that would enable much more of that diversity, rather than a pretence that they can rely on resources that are merely depleting at the moment.
	We need to ensure that we deal with the issues to do with fuel poverty and the high bills that people are being forced to pay because of the world energy markets.

David Anderson: rose

Elliot Morley: rose

Mike O'Brien: I shall give way to my hon. Friend the Member for Blaydon (Mr. Anderson) and then to my right hon. Friend the Member for Scunthorpe (Mr. Morley). I am conscious that time is limited in this debate, and I therefore do not want to give way too often as other Members will want to speak.

David Anderson: May I raise with the Minister the reality of the increase of up to 80 per cent. in the cost of domestic coal? A constituent of mine is now paying 9 a fortnight more than he was this time last year. In the debate about the cost of oil, electricity and gas, we should not forget that a lot of people in this country still rely on domestic coal.

Mike O'Brien: Domestic coal will certainly play a role in a diverse energy supply, and we want to ensure that it does.

Elliot Morley: I welcome my hon. and learned Friend to his new post. I want to pick up on the point made by my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham) during the statement about the windfall profits from the carbon credits to the generators. They are not exposed to international competition. That money basically goes straight on to their balance sheet. Is the Minister satisfied that there is proper scrutiny of where that money is being used and of whether it could be used to help the fuel-poor?

Mike O'Brien: We must ensure that we have the policy right. We are ensuring that that is so, but we also have to ensure that we balance the way in which the policy is developed over the coming months. We want to ensure long-term investment, too, and it is important to get substantial investment from companies in new infrastructure. Those companies will say that they want to make a good return on that investment. We will have to strike the right balance, but my right hon. Friend is right to suggest that we must always be aware that that balance needs to be struck with a great deal of care, bearing in mind the fuel-poor.
	I now wish to make progress. There is a limit on the length of my contribution, as I am sure those who want to contribute to the debate will recognise.
	My right hon. Friend the Prime Minister set out a new package of proposals for dealing with fuel poverty, and this debate is our first opportunity to outline what it contains. The new measures aim to reduce the amount of energy that households need, not just this winter but in the long term. They could help an extra 2 million households improve insulation and efficiency, and save them up to 300 a year in fuel bills. An additional 560 million obligation on energy companies is to be provided under the supplier's carbon emissions reductions targets to fund home improvements such as loft and cavity wall insulation. Eleven million elderly and low-income households will qualify for those measures, at no extra cost to themselves.
	This is about not just individuals, but communities. Gas and electricity suppliers and electricity generators will also contribute a further 350 million to a new community energy savings programme. That will support new and existing partnerships between local authorities, voluntary bodies and energy suppliers, and will provide intensive help to some of our most deprived communities on a house-by-house, street-by-street basis.

David Drew: Will my hon. and learned Friend give way?

Mike O'Brien: Given the time constraints, I regret to say that I will not be able to.
	Experience with existing schemes such as Warm Front suggests that a locally based approach, which offers householders face-to-face contact and advice, maximises the take-up of help available and addresses the problem of reaching every part of the community. As well as helping people to save energy this winter and in the long term, the measures announced will help households keep their bills affordable. This time last year, there were 365,000 customers on social tariffs; today, the energy companies tell me that there are more than 670,000, around three quarters of whom are guaranteed that there will be no price rise this winter.
	Earlier in the year, the Pensions Bill that I piloted through the House was amended to allow data to be shared with energy suppliers to help them to identify those poorer pensioners at risk of fuel poverty. When it is passed, the legislation will help suppliers to ensure that some of the most vulnerable customers have access to social tariffs and other measures.
	The measures that we have taken help the most vulnerable people pay their bills. We have trebled cold weather payments this winter, raising them from 8.50 to 25 a week. Homes that benefit from the community programme will also receive benefit entitlement assessments, which can add significant sums to the incomes of vulnerable households. The average annual increase in income where a household is found to be under-claiming is around 1,400, and of course we have increased winter fuel payments for pensioners over 60 from 200 to 250, and for those over 80 from 300 to 400.
	When I began, I said that the global context shapes our choices. When global prices rise, our circumstances and choices at home change. Thankfully, there has been a reduction in the oil price in recent weeks, and we want that to feed through into gas and electricity prices. The fact that gas companies buy ahead from their suppliers means that there will be a lag of about six months. However, given the movements of gas wholesale prices in a better direction, we told the gas companies at the meeting we held yesterday that we want them to give some indication about what they are going to do. We want the benefits of price changes to feed through to individuals who have to pay their bills, and as a boost to the economy as whole.
	Today, the Government have made it clear that the 80 per cent. target shows our commitment to ensuring that we give a high priority to dealing with climate change and to ensuring that we have an affordable energy supply. That is our commitment, and it is one that we will deliver on.

Charles Hendry: May I begin by welcoming the Minister warmly to his position? Perhaps it would be more appropriate to welcome him back, as he held the post for a few months four years ago. I also welcome his new ministerial colleagues, and I think that there will be some interesting discussions among that team. The Under-Secretary of State will be required to consent to new nuclear power stations and to the proposed facility at Kingsnorth, and that will be a fascinating process to watch.
	May I also use today's greetings as an opportunity to pay a warm tribute to the right hon. Member for Barrow and Furness (Mr. Hutton), who is now Secretary of State for Defence but who used to have responsibility for these matters when he was Secretary of State for Department for Business, Enterprise and Regulatory Reform, and to his former Minister of State, the hon. Member for Croydon, North (Malcolm Wicks)? Both really had begun to come to grips with the size of the energy challenge that we face. They did not do enough, but they had begun to understand the problem.
	We wish the Minister of State well in this important role, but we also have to recognise that people outside are frustrated at the number of changes that have taken place. The hon. and learned Gentleman is the 10th energy Minister in 11 years, and he was also the sixthjust as his predecessor was the seventh and the ninth. That shows this Government have a true commitment to recycling, but many people are frustrated about the changes that have taken place.
	There is also no doubt that this is a very challenging time for the Minister to take up his post. There is massive pain in households as fuel bills go up, and there is a real threat that companies may close as a result of the lack of competitiveness in our electricity pricing. In November, the forward price for electricity for business is one third higher in this country than it will be in France. We face an energy gap in less than a decade, when the lights may go out, and the current financial pressure makes the targets on renewables even more challenging.
	However, the charge against the Government is that they have made problems worse than they needed to be by failing to make decisions at the right time, and sometimes failing to make them at all. The Government have received warnings since the spring about fuel poverty, which was completely inevitable given the huge price rises coming through. Gas prices have risen by 50 per cent. since January, and electricity by 30 per cent., but the Government did not act until September. Of course we all agree that energy efficiency is vital, but it is not possible for enough to be done before winter starts, even though the warning signs were there.
	That will have catastrophic consequences for the Government's fuel poverty targets. They want to remove all vulnerable households from fuel poverty by 2010, and that is a legally binding target, but the numbers are shooting up in the wrong direction. We need clarity from them about whether they think that those targets can still be met.

David Winnick: The winter fuel allowance has been of considerable help since the Government have been in office. If the Conservative party is elected at the next general election, will the hon. Gentleman say that the allowance will be retained?

Charles Hendry: We shall make our financial commitments clearer as we get closer to the election. We have no idea whether the shortfall in public spending this year will be the 40 billion that was predicted, or the 100 billion that is now expected. We cannot begin to make spending predictions at this stage. The other thing to recognise is that this year's increase is for one winter only and not a lasting commitment.

Mike O'Brien: The hon. Gentleman has attempted to lambast the Government for failing to make decisions. Will he make a decision about winter fuel payments, as many pensioners will be very disturbed by what he has just said? While he is at it, what is the Conservatives' attitude to nuclear power? Does he still agree with his party leader that wind turbines are merely bird blenders?

Charles Hendry: The Minister could have addressed some of those issues in his own contribution. On winter fuel payments, we will make our position on financial matters clear as we move towards the election. That is not likely to happen for 18 months, and we expect to be able to make our spending commitments clear at that time. However, given that we have no idea of the extent of the mess that this Government will leave us with, we cannot give that clarity at the moment.
	I refer the Minister to the comments made by the previous Secretary of State with responsibility for nuclear power. He thanked the Conservative party for the constructive way in which we engaged with him and his officials to try to provide a secure platform for nuclear investors. We have said that we will work with the Government to provide security and a stable investment scenario. If the Minister had talked to his officials before making those comments in the House, he would have been better informed.
	However, the Government have rejected some of the proposals that would have helped them to deal better with the problem of fuel poverty. In the Energy Bill that is going through Parliament, we proposed that the Secretary of State should have powers to set social tariffs. That would mean that he would not have to consult, let Ofgem consult and then consult again: the necessary powers could have been included on the face of the Bill, so that he would be able to act if he decided that that was necessary. Without those powers, he will need to have primary legislation before he can act, and this winter will be over before he has that ability. It is a shame that our proposals were not accepted.
	The Government have abolished Energywatch and now, under pressure from other Governments, there are moves afoot to allow the European Commission to slip off the hook of tackling liberalisation.
	At the heart of this debate about energy providers is the issue of energy security. How can we keep the lights on in 2014-15, by which time most of our nuclear power stations and one third of our coal-powered stations will be out of commission? The Government have failed to establish a framework to bring forward investment in new energy generating capacities. As a result, we are seeing higher prices in this country, especially for business users. The prices are now above the European average.
	Critically, the Government have also failed to address the issue of gas storage. We have 14 days of gas storage in this country compared with 100 in Germany and 120 in France. In the cold period at the end of 2006, when we desperately needed gas to be imported through the interconnector with France, France was unable to provide it because it had legal requirements to keep gas storage facilities topped up. We need a real determination from the Government to push forward gas storage. That will be fundamental to our energy security.
	In spite of what the Minister says, the Government have been timid on the issue of carbon capture and storage. Even when they were telling us that the economy was doing well and the coffers were flush, they did not invest in more than one pilot project. They said that they would fund three projects from the receipts from the EU emissions trading scheme. [ Interruption.] The Secretary of State intervenes from a sedentary position. However, two potential technologies have been ruled out. Far from our being in a position to export expertise to China, China has opened its pilot project while we are still deciding who might win ours and it is determined to export its technology to us. We could have shown true global leadership and established a tremendous lead in a vital new sector, but the Government have allowed the opportunity to slip away.
	The Government should also be looking to show leadership by following our approach to emissions performance standards. We looked at the matter carefully. Initially, we had a concern about it; we have been persuaded that it is the right way forward. We need to be clear that it is not an anti-coal policy, but it is crucial for future investment that a clear framework be established.

Eric Illsley: The hon. Gentleman talks about carbon capture and storage. There are other methods of dealing with carbon. One is coal gasification and the other is burning coal in integrated combined cycles. All the prototype technology for our clean fluidised bed coal gasification programmes was abolished by the Conservative Government in 1988.

Charles Hendry: The hon. Gentleman makes a point about what happened many years ago, but we are nowas the Secretary of State saidin a very different set of circumstances. We have seen a significant move to gas, which has enabled us to meet our Kyoto commitments. We have not seen the necessary investment in new plant, and we have to look again at how we can give new life to coal. We have not reluctantly accepted this policy; we are passionately committed to delivering it because we think that coal has an important role to play in the future.
	The other aspect of the debate is low-carbon energy. While the Government have talked the talk in this area, they have not walked the walk. We have seen lots of targets, but we have not seen enough real action. The Government set up the marine renewables deployment fund with 15 million, but not one penny has been spent. They should be helping to market emerging technologies in which we can lead the way rather than setting rules that companies cannot meet.
	The Government consented to 33 GW of offshore wind, but they did not consult anyone in the industry about the feasibility of building that by 2020. The wind industry says that it cannot do more than 20 GW, so the Government have set a target that the industry does not believe it can deliver.
	In other areas such as smart meters we have offered the Government a way forward. Smart metering is a crucial element in encouraging microgeneration and tackling fuel poverty. It could be achieved in a decadebut not if the Government do not accept the framework. There has been some movement in the Energy Bill, but there is complete support in industry and among many politicians and environment and consumer groups for setting a timescale, and I hope that the Minister will go away and reflect on whether that could still be built into this debate.
	We have worked with the Minister's colleagues and others outside the House to push forward the case for feed-in tariffs for microgeneration. We are glad that that has been accepted now. We want to see the detail of how it will be done. It could have been done months ago when there was clear agreement across the House. We could have been making much more progress than we have made up to now.
	We have seen a Government obsessed by targets. They have a target of 10 per cent. of electricity from renewables by 2010, of 20 per cent. of electricity from renewables by 2020, 15 per cent. of our energy to come from renewables by 2020, all homes to be insulated by 2020, abolition of fuel poverty by 2016interestingly, 22 November 2016; we do not know if it is the morning or the afternoon, but we are told that it will happen that day for certaintargets to reduce carbon emissions and other targets. We need action rather than targets from the Government. People want delivery. We want to move away from the endless process of consultation. The conclusion of the smart meter consultation was that there should be three more consultation exercises. We have not had decisions. The Government have shied away when decisions have been essential.
	We are totally with the Government about the urgency of issues that need to be tackled, but we shall be able to deliver on the challenge of tackling fuel poverty, moving to cleaner energy and ensuring energy security only if the Government make real decisions and stop simply talking the language of what they would like to achieve.

Michael Clapham: I welcome the establishment of a new Department. It is long overdue. We had an energy Department, as you will be aware, Mr. Deputy Speaker, up to 1992. Since then, energy has been part of the integrated remit of the DTI. That has taken the focus away from some of the real issues, so it is good that we now have a Department of Energy and Climate Change.
	I want to concentrate on two things. The first is the increase in energy prices, especially gas prices and the knock-on effect on electricity prices. There are now just six energy companies in the market. There is an oligopoly. There are more inputs into the gas market, but the peculiarity of the gas market has meant that we have seen quite high gas prices. They have increased by 30 per cent. in the past year and electricity prices have increased by 50 per cent. That has had an enormous impact on domestic consumers and industry.
	When the Business, Enterprise and Regulatory Reform Committee took evidence from the Energy Intensive Users Group in spring, we were told that gas prices in France and Germany were 30 per cent. below those in the United Kingdom. I understand that across Europe electricity prices are 5 per cent. below UK prices. That has put British industry in a difficult position. Its competitiveness was challenged by those prices.
	When we look at why energy prices have increased, we see the indexation of gas prices to oil prices. The Select Committee took evidence from Energywatch. We were told by the chief executive that it was an irrational indexation and that there were other ways in which we might move. I accept that it would require an international endeavour, but I urge the Minister to consider whether we could embark on such an endeavour to separate gas prices from oil prices. The increase in gas prices has caused great hardship across the economy. As a result of the linkage between gas prices and electricity prices, high gas prices have driven up electricity prices. We have 33 per cent. of our electricity generated by gas and because those stations are the last to be called onthe marginal stationsthey set the electricity price for the whole market. High gas prices mean high electricity prices, because the marginal set that is called on is gas-fired. That causes enormous problems.
	The hon. Member for Wealden (Charles Hendry) mentioned price increases and when he was chided by my hon. Friend the Member for Barnsley, Central (Mr. Illsley) he said that we cannot look back and that we should not dwell on the past. However, the two factors that had an impact on the energy market came about as long ago as 1989. The Conservative Government allowed the use of gas in power stations. Until then, the use of gas in power stations had been restricted. Using gas in power stations has burned an enormous amount of gas, to the extent that this year2008-09the UK may be importing 40 per cent. of the gas we use. It is estimated that the figure will go up and that by 2018 the UK will be dependent on imports for 80 per cent. of its gas.
	The other decision that had a big impact on the energy market was that of the Conservative Government to abandon all the research that had been done on clean coal technology; they demolished the research unit at Grimethorpe colliery. That removed our lead and gave it to other countries, such as Scandinavia. China, too, is making a lot of progress on that technology. A number of factors have an impact on the price of gas. If we are to deal with them meaningfully, it will require international endeavour.
	The big six are in a much more influential position in respect of electricity, with an enormous say on electricity prices in the market. That does not mean that they sit down in smoke-filled rooms and come to an agreement on the price, but because there is an oligopoly of only six major electricity producers the price signals from one to the other are easily picked up and consequently they follow each other. Over the past year, all the energy companies have increased prices. To be fair, Scottish and Southern Energy did not increase its prices in April; it waited until the end of the winter. Nevertheless, all the companies have increased their prices, by 50 per cent. and 30 per cent. for gas and electricityand that has had an enormous impact.
	What can we do to deal with electricity prices? Is there a way to reduce them? The price of oil has already come down from $146 a barrel in July to $81 a barrel this week. That means that the gas price has also started to fall, which is likely to bring down inflation from the 5.2 per cent. announced this week. At the same time, we have to be aware that there will be a fall in economic activity in the UK that will also have an impact. Although on the one hand, energy prices are beginning to fall, on the other we shall have to deal with a difficult situation with more people out of work as the economy begins to slow.
	The Government can do more to deal with the situation, especially with regard to the EU emissions trading scheme, where the energy companies are set to make an enormous amount of money. They have been given free permits and Ofgem reckons that the price of carbon will increase by 9 per tonne, so taking that figure right across the industry, the companies are likely to make 9 billion over phase 2 of the European emissions trading schemefrom January 2008 until 2012. There is an opportunity to consider whether there is room for a windfall tax on that windfall profit. An enormous amount of profit will be made, so there is an opportunity and the Minister may already be considering the possibility of a windfall tax. We could use that money to start to tackle the big issue of fuel poverty.
	The hon. Member for Wealden asked how many people were already in fuel poverty as a result of the price increases. We know that for every 10 per cent. increase in energy prices, 400,000 households are put into fuel poverty. When we consider the gas price increase of 50 per cent. over the past year, we realise that we could be talking about 2 million households being put back into fuel poverty. The energy companies have a social responsibility. If they do not make money available to deal with fuel poverty from the profits they are making, the Minister must seriously think in terms of a windfall tax.
	There is another aspect that we must look at carefully. The one thing that we could not do in the BERR Committee when we looked at energy prices was determine where the profit was coming from. On the one hand, the wholesale gas price goes up and on the other, because 30-odd per cent. of electricity is generated from gas and gas prices increase in relation to oil, the price of electricity also brings a profit. There are large profits in the wholesale area of gas usage and the Minister may want Ofgem to concentrate on that in its regulation of the energy industry. If that can be done, it could provide another opportunity to work with the energy industry to tackle fuel poverty.
	All in all, a number of things can be done. We need transparency in the forward gas market, which is not there at present. Some gas companies, in previous acquisitions, bought companies that had long-term gas contracts, and the Minister may want to consider whether those contracts are anti-competitive and what we might do to loosen them up so that they are conducive to more competition. That certainly needs to be looked at.
	We should also look at the enormous amount of profit that will come from phase 2 of the European emissions trading scheme. In the Minister's previous role, he was close to what was being done on clean coal technology and carbon capture and storage, but there has been such delay. I understand that this year we have listed four companies for further negotiation, but we are not likely to choose one for a contract until next autumn. That is too long. We need to expedite carbon capture and storage. That is not just to deal with coal-fired stations, although that is an important aspect; a gas-fired station produces about half the CO2 emissions of a coal-fired station, so we need to ensure that we use carbon capture and storage on gas-fired stations as well.

Eric Illsley: My hon. Friend has hit on an important point. Carbon capture and storage could be some time away. The demonstration plant is still only at competition stage and a decision has not yet been made. There is a technology we could use in the interim, which has been around for a long time and can be retro-fittedthe system of removing carbon pre-combustion. In the old days when we had town gas and coke works, there was a simple method for removing carbon from coal before it was burnt. I hope to host a reception on 3 November, to which my hon. Friend will be invited, which will hear about a technology that does exactly that. We could use coal gasification or clean coal technology in advance of carbon capture and storage.

Michael Clapham: I am grateful to my hon. Friend for that intervention. I know that the Minister heard what my hon. Friend said and may well be at the reception that he is hosting.
	There are some important measures that we need to take pretty speedily. Carbon capture and storage is one, because it would allow us to deal with the crisis that will arise between 2012 and 2016 with the simultaneous closure of some of the coal-fired stations and nuclear stations. We therefore need a technology that we can use to reduce emissions, because if the gap is filled by gas-fired stations, it will not reduce CO2 emissions. Those emissions will increase, and we could eventually have gas-fired stations, nuclear stations and renewable input, and yet produce a greater amount of emissions because of our emphasis on gas-fired stations. Given that we are likely to be importing 80 per cent. of the gas that we use in the UK by 2018, the Minister might consider putting a cap on the number of gas-fired stations that we will allow in the energy economy.

Alan Whitehead: rose

Mr. Deputy Speaker: Order. Has the hon. Member for Barnsley, West and Penistone (Mr. Clapham) finished his speech, or is he giving way?

Michael Clapham: I was giving way, Mr. Deputy Speaker.

Alan Whitehead: I thank my hon. Friend for giving way. I wonder whether he wishes to add the words combined heat and power to his thoughts on gas-fired power stations. I am thinking not just of the need to make any new gas-fired power station that should come on stream CHP-ready, but of the need to provide a heat network to deliver the captured heat from such a gas-fired power station, which would double its efficiency.

Michael Clapham: I am grateful for that intervention. It is important that we ensure that we have CHP units, and using CHP with the gas-fired stations would make them really efficientmuch more so than at present.

Steve Webb: I shall address my brief remarks to the title of the debate, Energy providers, and move from the very micro to the macro.
	I want to draw the Minister's attention first to an issue that was drawn to my attention by a local resident, who received a letter at the start of October from her energy company, telling her that at the end of August it had raised her prices. I queried that with the company, and it told me that that was perfectly legitimate, because under Ofgem rules, energy companies have six weeks to tell customers that they have put their prices up.
	It is very hard to think of any other form of trade in which one continues to consume a product for six weeks, only to learn from the provider that it was charging more six weeks ago. Will the Minister look into that? It worries me that many people who are getting estimated bills, or who are paying by direct debit at a level that is below their current consumption, will face really big hikes in their monthly outgoings, and if they are not told until six weeks after, the market will not work, because they will not start shopping around for a better price if they do not know that the price has gone up until six weeks afterwards.
	Secondly, I want to explain one of my whacky ideas, which will become received wisdom very soon. As the new Minister has not had a chance to hear it, I want to raise with him the idea of what I call the super-smart meter. The Secretary of State said a few minutes ago that many people who switch do not actually switch to a better deal. We also know that the poor tend not to switchand that they tend not to have internet access. Will the Minister ensure that when Ofgem specifies what a smart meter looks like, one of the functionalities it puts into it is that the meter does the switching for the consumer?
	The meter needs to be able to communicate with the outside world in order to be a smart meter. Why should it not go to a price comparison site, on behalf of the consumer, knowing the consumer's pattern of consumption of gas and electricity or whatever, and shop around for the best price? Then we would not have the problem that the Secretary of State mentionedthat the consumer swaps supplier and then a week or a month later things have changed and they ought to swap again. The meter could monitor the market on behalf of the punter. It could be possible to lodge one's bank details with a central clearing house, so that it was not necessary to have one's bank details with 100 different companies. Then there would be real competition in the marketalmost the economist's picture of perfect competition, because the meter would do the switching. I hope that the Minister will pursue that idea.
	My right hon. Friend the Member for Gordon (Malcolm Bruce) mentioned earlier the issue of people who are not on mains gas. That is a big issue. Funnily enough, it does not occur only in rural areas; in a surprisingly large number of places, people just are not on mains gas. When we bought the house that we live in, 15 years ago, it did not have mains gas, and all the houses along the row had oil tanks in the garden. I have not yet heard what we are going to do about fuel poverty for these people. The big six do not provide the non-electricity power; they do not provide liquefied petroleum gas, by and large, or heating oil. I think that the Secretary of State hopes that the big six would address that group, but by and large they are not selling to that group, apart from electricity.

Malcolm Bruce: Can my hon. Friend appreciate the insult that is added to the injury when consumers receive through the door invitations from a gas company that does not supply them to opt for dual fuel? Does he find it interesting that since the privatisation of the gas industry, the extension of the gas network seems to have ground to a halt? There seems to be no incentive to give people gas.

Steve Webb: Access is a very real issue, as my right hon. Friend says, and of course the absence of dual-fuel tariffs for these people is an extra penalty. Not only do they pay a lot when the price of heating oil goes up, but they do not have access to dual-fuel tariffs either. The regulator could do something about that.

David Drew: Does the hon. Gentleman accept that there is a real problem with the Warm Front programme? Many of the people who are off the mains gas network are living in older property, and the current cap is causing them enormous problems. They will almost certainly have to pay more than they will get in grant, and something needs to be done desperately quickly about that.

Steve Webb: The hon. Gentleman makes an important point. I will return to the issue of home insulation programmes.
	I shall stay on the issue of fuel poverty, and the figures that I referred to earlier this afternoon. I asked the Library to look at single pensioners, to rank them by quintile from the poorest to the richest, and to look at what they spend on fuel and what their actual incomes are. The Library projection, on figures provided by the Office for National Statistics, was that not just the poorest quintile were on average in fuel poverty this autumn, but the second, third and fourth poorest quintiles. All quintile groups except the top fifth were on average in fuel poverty this autumn. The scale and the urgency of the problem are absolutely incredible.
	The Minister said that two thirds of a million customers were on social tariffs. That is great for the two thirds of a million, but that must mean that if fuel poverty is running at well over 3 million, and possibly at 4 million or more, the vast majority of people in fuel poverty are not getting social tariffs. It is not just that the glass is half full or half empty; it is about a sixth full. That is the scale of the problem. So how do we get social tariffs through to the fuel-poor on a much greater scale?
	I want to address the issue of the companies. The Secretary of State has had a meeting with them and that is great; his predecessor had meetings, and the Prime Minister has had meetings, but we are not getting out of them what is needed. The Secretary of State saidI believe he did so in  The Guardian this morningthat he hoped that the companies would not pass on the cost of the home insulation scheme to consumers, but he can hope all he likes; the companies can do it, and the consumer can do nothing.
	Surely, Ofgem should be stopping the companies passing on the costs of these social measures. If it is a duty on the companies, the customers should not be forced to pay. The shareholders should be forced to pay, because as was said in a previous contribution, the generatorsnot the distribution companies, although obviously there are some pretty close linkshave had this huge windfall, according to Ofgem. In my view, one does not have a windfall tax that takes the money off them and then spends it; one places a duty on them to do the things that one wants them to do. In our view, we go very much further down the track than the Secretary of State said in terms of neighbourhood energy efficiency.
	The problem with the carbon emissions reduction target is that a road with six houses can be served by the six different companies, and six different men in six different vans can go down to help that company achieve its CERT obligation. As the hon. Member for Stroud (Mr. Drew) said, there are great variations in the types of houses and in different areas. We need a neighbourhood- based approach on a massive scale. The problem with Warm Front is that it adopts a piecemeal approach, although it has done good work. Local authorities know their neighbourhood. The answer will be different in Stroud and in South Gloucestershire, for example. We need substantial money from the supply companiesa windfall duty on themto deliver systematic energy efficiency. Yes, as the Minister said, they can provide benefit advice tooif someone is going to knock on those doors, they might as well ask that set of questions as wellbut I think there is a paucity of ambition here. Literally millions of pensioners are affected, and I would mention, too, disabled people below pension age who do not qualify for the winter fuel payment but who may face extreme heating bills that they have no choice but to incur.
	There is a serious worry this winter, particularly for people on pre-payment meters, about self-disconnection. We do not see those people in the headline figures, and I hope that the Minister will ask the energy companies how much that happens. People on pre-payment meters simply do not have the money to top them up, and they just switch off the power. That does not feature in disconnection statistics, because no one disconnected themthey disconnected themselves. That could well be a hidden disconnection scandal that gets worse this winter. There are some serious issues for consumers, as the problem is imminent. Further consultation on possible legislation simply does not meet the scale and urgency of that problem.

Several hon. Members: rose

Mr. Deputy Speaker: A time limit was not imposed on Back Benchers' speeches, and I see that two more hon. Members wish to take part in the debate. There will be slightly less than 40 minutes left, if we allow the Minister two or three minutes for his winding-up speech, so perhaps hon. Members will keep an eye on the clock. I call Dr. Alan Whitehead.

Alan Whitehead: In welcoming my hon. and learned Friend the Member for North Warwickshire (Mr. O'Brien) to his new post as energy Minister, I sympathise with the dilemma that he faces, particularly in the light of the statement immediately before this debate about energy providers and how they will provide our energy in future, as well as the compatibility of those choices with our goals and the need to make a positive contribution and keep the lights on.
	That process has been likened to attempting to change at least one wheel on a car while steering it along the road and making sure that it does not go into a ditch. It is a serious issue, and my hon. and learned Friend has mentioned the high investment required in the energy economy over the next few years to keep the lights on and to move our energy supply in a different direction. We have to replace 40 per cent. of our generating capacity over the next 15 years, as it is not just coal-fired power stations that are being decommissioned under the large plant directive but nuclear power stations and, indeed, older power plants, which are being retired on the grounds of age.
	Furthermore, we have to look fundamentally at the question of wholesale renewal of large sections of the national grid, and its ability to supply energy from power stations. In particular, as we deploy new forms of power generation, such as large-scale renewables, there will be a growing queue for connection as the grid runs into problems when dealing with different connections for new forms of energy and continues to try to provide the wherewithal to transfer energy from the north to the south and to achieve a fair distribution of the products of those power stations.
	We have heard mention of smart meters, which are not just a good idea for the future but a long overdue investment. There is still a clockwork economy in metering in an era of computers and internet communication. Metering in the UK is not fit for purpose, and it does not fulfil the requirements of the energy supply.

David Taylor: A moment or two ago, we heard the Liberal Democrats' suggestion for an upgrade to smart meters that would allow meters to select a tariff. Does my hon. Friend, like me, think that that suggests computers that track shares in stock exchanges, which then cause prices to plummet? The logic would be that everyone on such smart meters would switch to a cheaper supplier, so there would be real instability.

Alan Whitehead: The hon. Member for Northavon (Steve Webb) and I have discussed his interesting proposal for super-smart meters, but I agree with my hon. Friend the Member for North-West Leicestershire (David Taylor) that the danger arises if one applies the prisoner's dilemma theory to that bright idea. It may well be the case that all the meters would switch to a single supply at the same time or, alternatively, there would be a constant, chaotic switching, because perfect information about a market would be available.  [ Interruption. ] Indeed, markets operate only on the basis of imperfect information, as the hon. Member for Northavon knows from his studies, so there would be a problem.
	I would prefer to characterise meters as smart, smarter, and super-smart according to what goes into them and what they can do. It is not just a question of giving a real-time reading, so that someone's energy supply is under their control to a far greater extent. People should be able to read the meter by getting it to deliver a signal either via computer or to a remote reading facility, so that they are not waiting at home all day for someone to come and read a clockwork meter at 3.30 pm, when they said that they would do so at 9 am. It is a question, too, of the extent to which meters are two-way, incorporating energy generation as well as energy supply, and can do things such as responding to dynamic demand in the householdswitching off devices when they are not neededthus reducing the cost of supply.
	When we make decisions about smart metersit is urgent that we do sowe must ensure that those meters are rolled out in the best possible way. We need some form of area franchise, rather than each company looking after their own meters. It is important that we get smart meters right, otherwise we will simply install a new generation of clockwork meters to replace the old generation. Given the radical change in the way in which energy will be supplied in future, it is essential that meters are up to the task of making sure that the different form of supply can be properly mediated by householders.
	We have to make those changes, but the need to reinvest in our energy economy in a substantial way poses a dilemma. Unless one suggestsI do notthat all the energy supply companies should be nationalised immediately, it is extremely likely that that investment in all those different forms will largely be down to the energy companies, and it is essential that they can make that investment. It is important, too, to place that new investment in the context of the long-term prospect of high energy prices, regardless of the volatility of the market.
	Under those circumstances, I wonder whether the idea of a windfall tax that simply gives people money to become competitors in getting expensive energy supplies and to give the money back to energy companies so that they can provide them with more expensive energy supplies is necessarily the smartest way to go forward. I suggest that when we are looking at the renewal of our capacity, we should approach it in different ways. Renewing our power plants will be achieved by means of different devices. We will have to introduce a substantial amount of renewables to replace existing power stations. In traditional power stations, we will have to introduce different ways of ensuring that their output is efficiently captured and that the emissions are properly controlled. Carbon capture and sequestration means combined heat and power and measures to ensure that the use of the fuel is efficiently discharged for the production of electricity.
	With reference to the grid, I am attracted by the elision in Chinese of the words danger and opportunity. Will we say to energy suppliers, We ought to be reorganising and restructuring the grid, but we will reorganise it in the same way as it was previously organised, when we know that we are moving into an energy economy of distributive energy, with households producing electricity and that going into the grid in ways for which the grid was fundamentally not designed? The grid is essentially a spine system going down the country, linking very large power stations with what one might regard as dumb terminal users.
	One is reminded of the statement that the chief executive officer of IBM made in the late 1940s, when he was asked how many computers he thought the world would need. He said about six, on the basis that there would huge computers with long terminals with dumb ends on them. That is not how the energy economy will work over future decades. The grid must be resupplied, so that it works for renewables and decentralised energy. Should it go on land or sea? Can we envisage the connection of offshore wind with this country and interconnections with other countries, serving also as a grid device for distributing energy round the country? Can we make an opportunity of the dangers in such a way that the companies supplying energy reinvest in the grid, in power stations and in meters to make them fit for purpose and for the way in which the energy economy will run in future?
	That brings me to the way in which we should approach those energy companies. In the new energy economy, with the sort of goals that we have heard about today, it is absurd that we should continue to envisage energy suppliers being required in future to provide each and every one of us with as much energy as they can at the highest price they can, and that that is how they will make their money.
	Yes, of course energy companies must make money for the tasks of investment and supplying energy in future, but a far better paradigm is to develop ways for them to cease to be energy supply companies and to become energy service companies engaged in contractual arrangements with commercial or domestic customers. The energy supply companies would invest, along with the customer, in saving energy, installing energy production and energy-efficient devices, making sure that the energy provided is the smallest amount possible and that the proceeds that arise as a result of that contract saving money are split between the householder or company and the energy supply organisation.
	The opportunity and the danger come together in a new paradigm for how we deal with our energy supply companies, first, in the interests of arresting climate change; secondly, to the benefit of our energy security by ensuring that we use less energy and use it far more efficiently; and thirdly, by re-equipping our energy infrastructure to deal with the problems of the 21st century, rather than the 19th century, which it appears at present to be designed to do.

ROYAL ASSENT

Mr. Deputy Speaker: I have to notify the House, in accordance with the Royal Assent Act 1967, that the Queen has signified her Royal Assent to the following Acts:
	Appropriation (No. 3) Act 2008
	Health and Safety (Offences) Act 2008

Energy Providers

Question again proposed, That this House has considered the matter of energy providers.

Philip Hollobone: May I invite the Minister to visit Kettering, which faces several issues relating to energy providers? Local residents would appreciate the chance to hear his views, and he might learn about some developments that are pertinent to his portfolio. The first issue is an innovative scheme that Kettering borough council is undertaking with the energy provider E.ON UK to encourage people to reduce their energy consumption, and the second concerns the location of wind farms.
	Kettering borough council, of which I am pleased to be a member, and E.ON have launched an innovative new pilot scheme that offers residents in the borough the chance to earn monetary rewards, if they reduce the amount of energy that they use over the year. The scheme basically gives instant accurate information on energy consumption, to help consumers reduce the energy that they use in their homes. The scheme involves installing dual-fuel smart meters in the homes of around 500 existing E.ON customers in the borough, enabling them proactively to monitor their home energy use and adjust their energy consumption accordingly. The scheme starts next month and will run for 12 months. Should the pilot be successful, one of the leading housing developers in the area is considering using the technology for new developments, as housing expansion in the region takes off over the next 10 to 15 years, to make Kettering borough and north Northamptonshire an exemplar low-carbon region.
	Through the use of such smart meters, households will be better able to understand the energy consumption of the different products in their homes. Customers who sign up for the trial will have their homes fitted with the new smart metering technology for free. They will also be provided with a smart energy monitor, which communicates wirelessly with the meter and enables them to see their energy consumption instantaneously. The technology will also provide access to a new online smart energy tracker system, whereby customers will be able to monitor their progress against their energy saving goal. The incentive is that if customers reduce their energy use by 5 per cent., they will receive 50 from the borough council, and if they achieve a 10 per cent. saving, they will receive 100. Customers will also benefit from lower energy bills, because their consumption will be less.
	Let me turn to wind farms. Residents in Kettering are supportive of renewable energy. We have a wonderful wind farm at a place called Burton Wold. There are 10 turbines, and the local authority has given permission to increase that to 17. Indeed, permission may be given in future to expand to 24 turbines. The wind farm currently supplies the equivalent of 10,000 households out of the 36,000 households in the borough, although that figure will increase as the number of turbines increases. The wind farm is not universally popular, but it is fair to say that the balance of opinion locally is strongly supportive of the Burton Wold wind farm, especially in Burton Latimer. Local schoolchildren in the town have named each of the turbines, and there is a substantial grant each year from the wind farm company to the town council to help with local community projects.
	However, local residents in my constituency, which includes the borough of Kettering and one third of Daventry district, do not want to see lots of wind farms being built all over the local countryside. Five planning applications are likely to be made for additional wind farms, at Rushton, Great Cransley, Harrington, Kelmarsh and Brixworth. Some of those applications are for wind farms in extremely scenic parts of the local countryside. Kettering borough council and Daventry district council both face a challenge in trying to balance the Government's understandable objective of increasing the number of wind farms with the strong views of local residents, who are saying, Yes, we're supportive of renewable energy, but not in every case.
	It would be reasonable for the Government to adopt a policy whereby they could tell local authorities such as Kettering borough council that if they are a champion of a wind farm that delivers demonstrable and sizeable benefits to the local community, as the Burton Wold wind farm does, they should be able to use that support to stop other wind farms from being built willy-nilly all over the countryside. That would strike a fair balance between the Government's laudable objectives of encouraging more renewable energy and reducing our dependence on foreign fuel imports, and the understandable concern of local residents, who do not want to see some of the best countryside in the middle of England, which has historic connotations, being destroyed, potentially for a long time, by some very tall structuresthey are far taller than Big Ben or Nelson's columnthat are likely to remain for 20 or 30 years.

Siobhain McDonagh: I do not propose to speak for long this afternoon, as I have secured an Adjournment debate on a similar subject tomorrow. I have called the debate on behalf of my constituents, Michelle and six-year-old Jayden, who had their gas cut off by Scottish Power in June and who have been left without cooking, heating and hot water for four and a half months. I am concerned that Michelle and Jayden's story is just the tip of the iceberg, and that thousands like them are being treated just as badly by the energy providers.
	I am pleased that this has been chosen as the subject for today's topical debate, because it enables us to raise an important principle: should people like Michelle and Jayden be left in the cold when they have no chance of paying what the utility companies demand of them? I do not intend today to go into how they got into arrears, but Scottish Power has been charging them an incredibly high amount for their gas: 75 a month for a small, two-bedroomed housing association flat. That seems like a very high tariff to me. We all know that people on low incomes are rarely on the most generous tariff. This has been a cause of real concern, and the Government need to do morein line with today's statement and the meeting with the companies yesterdayto stop the poorest being charged the most. As I am sure everyone in the Chamber today knows, pre-payment meters penalise people heavily. Ofgem says that people who use them pay 125 more than people who pay by direct debit.
	However, Michelle and Jayden are in such a bad position that they actually want a pre-payment meter so that they can cook a meal, have a bath and heat their front room. But Scottish Power says no. It says that it cannot do it, and that Michelle needs to have extra pipework done in order to install a pre-payment meter, and that that is not its responsibility. Scottish Power says that it is the responsibility of another utility company, Southern Gas Networks. Southern Gas Networks says, Fine, we'll do the work, but it will cost 350. And, after all that, Michelle is going to have to pay a CORGI-registered engineer even more to fit the meter. So, even though Michelle is in great need, she has been told that she has to pay for everything. That cannot be right. Not only are the utility companies ripping off our least affluent constituents by charging high tariffs, but they are trying to get them to pay hundreds of pounds for the privilege of having a pre-payment meter that no one here today would want, and I am told that all this is legal.
	Scottish Power does not seem to be particularly bothered. Its best effort to justify its behaviour has been to tell me that it did not know that Michelle was on income support, or that Jayden was six and that he lived in the same house as his mum. It also says that it has not been able to get through to Michelle, but, to be fair to her, every time I have called her, she has answered my calls quickly and has always been prepared to provide even the most uncomfortable information. Just yesterday, Scottish Power admitted that Michelle had called it on numerous occasions, although until then, it was adamant that it did not know about her circumstances and that she had refused to return its calls. From my experience of Scottish Power, I can easily believe that it would not have asked her about her circumstances. I wonder whether the Government would consider ensuring that questions about people's circumstances were legitimately asked, and that it could be proved that they had been asked. I want the Government to do something about companies such as Scottish Power, which now knows everything about my constituents but still refuses to budge. It still wants Michelle and Jayden to pay hundreds of pounds that they clearly do not have, for a meter that none of us would ever want.
	I will go into more detail in the Adjournment debate tomorrow. This practice is simply not right. It might be legal, but none of us would regard it as right to leave a family without hot water, heating or cooked food for four and a half months, and into the long-term future. Trying to charge Michelle around 500 for a new meter that she cannot afford is not right. I do hope that Ministers will listen to this debate and reflect on this story.
	The utility companies spend an enormous amount on public affairs. Scottish Power is part of a company that made profits of 200 million last year. I hope that it will reflect for a moment on what it would be like to be my constituents. It is time that the utility companies learned the importance not only of talking about social responsibility but of living it.

Malcolm Bruce: This has been a useful debate and the statement we heard before it was extremely helpful. I thank the Secretary of State for acknowledging, in response to interventions from me and my hon. Friend the Member for West Aberdeenshire and Kincardine (Sir Robert Smith), that the Department will engage with the issue of domestic fuel prices. I hope that the Minister will take that forward. To reinforce that message, it is estimated that 4 million people are not on the gas mains; they are losing out because they do not have access to dual tariffs and the rebates that go with them. Many are dependent on fuel oil for their central heating, but its price has gone up hugely and it is not coming down. It is important for the Government to understand that those people simply do not have an option.
	I have two further points on that. The first is about what the Government can do to ensure that fuel prices come down in a way comparable to other prices. A Library briefing shows the extent to which prices have gone up, with graphs demonstrating domestic fuel oil spiking way above all the other prices that none the less seem to get more attention. Secondly, technical innovation is important. I should perhaps declare an interest as one who, like many of my constituents, lives in a rural village and is dependent on fuel oil for central heating.
	One issue of concernit is an old oneis the gas main. Since the privatisation of gas, the extension of the gas main has almost stopped, yet a significant number of communities, villages and towns could access gas if someone were prepared to connect them to the mains. Gas companies tend to say, Go and find us a market, and we will consider whether we will supply it. The Government could do more to encourage the extension of the gas main.
	The Government could also help people to find alternative technologiespreferably renewable energy technologies, which are much more efficient. Most people do not want oil. They would much prefer a more environmentally friendly source, but they need help to find out what it is. At the moment, the technical innovation advisory services do not provide any useful answers. I really hope that the new Department will view that as something to which it could usefully devote its attention.
	The role of smart metering has been discussed in a valuable way, and I note that my hon. Friend the Member for Northavon (Steve Webb) put forward an interesting idea. I understand the issues raised in that context but, after all, competition and its effectiveness are also about information. The Secretary of State clearly acknowledged that the current system does not work very well. My hon. Friend put forward an idea that has merit, but we need to work together to try to find ways of giving people the real ability to make intelligent choices that will help them get the best fuel bills and make competition work more effectively.
	I shall be brief, as I want to give the Minister time to reply, but my other main point is about fuel poverty. According to NEA, the fuel poverty group, 5.2 million households now face fuel poverty. The figures on pensioners that my hon. Friend the Member for Northavon provided from a Library analysis were also pretty startling. It boils down to this: I do not know of anyone who is not concerned about their fuel bills, irrespective of whether they consider themselves fuel poor. An increasing proportion of almost every household's income is going on fuel bills.
	In the long run, we need a low-carbon energy system, but we need the transition to take place in circumstances in which people are not faced with violent peaks and troughs, which make it difficult for people to adjust. I thus wholly support the objectives of the new Department and the low-carbon strategy, but I urge the Government to help the industry bring on new low-carbon technologies faster. I hope that they will be able to achieve that, as it is what many people are looking for.
	I understand why the Secretary of State said that he wanted to proceed slowly, but the Government will have to look further into the law on regulation. It seems to me that if action is going to be taken to require energy companies to pass on changes to prices efficiently and to provide social tariffs, it will have to be done within the framework of new regulations for Ofgem. I do not see how the Government can achieve their objective otherwise. I also think that that would be a far better answer than windfall taxes, to which I have an inherent resistance. I believe that they damage the market in the long term, and discourage investment.
	Let me issue a plea that I consider important. The Minister has been responsible for this matter in the past. I was encouraged by the Prime Minister's comments to the Liaison Committee in July, which the Minister effectively reflected today. The Government have acknowledgedsomewhat late in the day, but I welcome itthat we have passed the peak of oil and gas production from the United Kingdom North sea and that it will be more difficult to get the rest of it out. However, there is a lot of it out there, potentially nearly as much as we already have. I find it very encouraging that the Government now appear to understand that sudden tax changes and treating the industry as a revenue source is not the answer. What the industry needs is the confidence to invest in the long term in a highly competitive environment in which the North sea is very expensive.
	We have built up an infrastructureespecially in my part of the country, the north-east of Scotlandthat is servicing the world in oil and gas and offshore technology and that is hugely valuable to the British economy in a variety of ways. I hope that the Government, through PILOT and in partnership, will ensure that we maximise our own production at the same time as moving towards a more low-carbon economy and more diversified energy provision.
	Climate change issues affect the rest of the world as well, and I hope that the Government will not allow us to adopt policies in this country that penalise the poorest countries in the world. We must recognise that what we do here must be in partnership with poor countries, and that we must enable them to cope with the real challenges that they face. In the last two weeks, the World Bank has pointed out that whereas at the beginning of the year 1 billion people were living on less than $1 a day, the figure is now 1.4 billion. Those people simply cannot cope unless we treat them as partners in the enterprise.

Mike O'Brien: We have had an enormously useful debate, featuring some very helpful speeches. In the time that remains, I shall try to deal with some of the helpful points that were raised, as well as some of the less helpful.
	My hon. Friend the Member for Barnsley, Central (Mr. Illsley) referred to the windfall tax. I share his concern about price and fuel poverty, but it should be borne in mind that we have just asked the energy companies for 910 million for the package recently announced by the Prime Minister. Admittedly the amount was to be provided over three years, but the energy companies responded, and I am not sure that this is the right time to go straight back to them and say We now want some more. Moreover, as we all know from the headlines, there are financial issues in the world today. There are times when it is right to do this sort of thing, and times when it is not. Having said all that, I should add that matters of taxation are matters for the Chancellor.
	I was struck by an interesting point raised by my hon. Friend the Member for Southampton, Test (Dr. Whitehead). He questioned the idea of taxing companies that would then increase charges, suggesting that it was difficult to ensure that the increases were not passed on to customers. In the long term, we must ensure that we secure investment from those companies, which will want to receive a fair return. We also need to create an environment in which we attract overseas investment: that will be particularly important.
	In that context, I should tell the House that this morning I had a meeting at No. 10 Downing street with E.ON and Masdar, a company from the United Arab Emirates, which have joined forces on the London Array offshore wind farm project. When built, the wind farm will be the world's largest offshore scheme, and the partnership between oil-producing and oil-consuming countries will help to develop new energy sources and technologies. The sheer scale of this ground-breaking project, involving 1,000 MW makes Britain a world leader in offshore wind technology. I welcome that, and the foreign investment that will ensure that it happens.
	The hon. Member for Kettering (Mr. Hollobone) kindly invited me to his constituency and put up a very good case that it was well worth a visit. I would like to see the innovation, particularly that by the local authority and E.ON. I would also be interested, having come from a portfolio that dealt with pensioners, to see how the local authority is dealing with the elderly person, perhaps over 80, who suddenly gets all this information about how much money they are spending and decides to cut down on their heating. We want to ensure that people are properly informed, but we also want to ensure that we do not create a killer. That will be important. How we deal with that in terms of smart metering is something that I want to be sure I am entirely satisfied with. However, he makes a good case and I will consider his kind invitation.
	I know the speeches of the hon. Member for Northavon (Steve Webb) well from the pensions portfolio. He always comes up with a raft of good ideas, and some not so good, but they are always interesting. I was particularly struck by some of the points that he made, and I will take up some of those issues. He and the right hon. Member for Gordon (Malcolm Bruce) raised the need to get connected and rural gas contracts. I face that problem in my constituency. In the town of Kingsbury, we managed to get a group of local people, both householders and tenants of the local authority, to create a market and to get the local authority to work with them to get connections put in through Transco. We are now on a much bigger project. I went to the local authority and suggested that we do that and it has responded, albeit there has been something of a delay. However, it has managed to start the project of getting gas connected to large areas of a very rural constituency. Local authorities have a role, therefore. If we can get enough people together to create a market, it is possible to get those connections done, but I assure both Members that I will look into the matter.
	On North sea oil and gas, the right hon. Member for Gordon is right. Those resources are more difficult to access but they are important none the less and we must work to see whether we can create the right environment for them.
	I am concerned by the case raised by my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh). Perhaps I can deal with it in more detail on another occasion, but those who install prepayment meters under the terms of their supply licence must take into account customers' ability to pay. She might be aware of that. Customers on benefit may be able to pay by fuel direct. That may be another point that is worth canvassing.
	The contribution of the hon. Member for Wealden (Charles Hendry) was extraordinary. Pensioners throughout the country will now be concerned by the position of the Conservative party in relation to winter fuel payments, and the refusal to say that there would be any winter fuel payments. That puts in grave doubt the winter fuel payments and any help with fuel payments for those who are still facing quite high fuel bills. Despite his protestations in relation to nuclear power, it is the case that his party leader said that nuclear energy was a last resort and that the then shadow energy Secretary, the hon. Member for Rutland and Melton (Alan Duncan), specifically denied that it had been Conservative policy to support nuclear power. He said:
	'Last resort' wasn't really a policy. It was two words in the document which we binned months ago.
	We need more clarity from the Conservative party about that. Can we also get some clarity in relation to wind turbines? Calling them wind blenders is not a policy and we need
	 It being one and a half hours after the commencement of the proceedings, the motion lapsed, without Question put, pursuant to the Temporary Standing Order (Topical debates).

Primary Care

Ben Bradshaw: I beg to move,
	That this House has considered the matter of access to primary care.
	Even before the NHS was born 60 years ago, Nye Bevan recognised that, for it to stay relevant and to retain public support, it had constantly to change and improve. Primary care, as the gateway to the NHS and the upholder of its values, is in the vanguard of that change. I would like to share with the House the ways in which the Government are reshaping primary care for the 21st century: how we are listening to patients and letting them lead the way; how we are pushing power down to local level to primary care trusts, giving them the freedom, finance and support to transform primary care; and how we are doing more than any previous Government to improve access to primary care so that the hard-working men and women who pay for the NHS through their taxes can benefit from it at a time and place convenient to them.
	In the 11 years since this Government came to power we have put unprecedented investment into primary care, supporting a massive increase in new staff and modern premises and improved services. Funding has more than doubled. Investment in GP services has increased from just 3 billion in 1997-98 to 7.86 billion in 2006-07. There are 5,300 more GPs and 4,500 more practice nurses. The average length of a GP consultation has risen by 50 per cent., from 8 to 12 minutes, and outcomes for patients have improved, and patient satisfaction in England with GP services has risen. In 1997, fewer than half of all patients could expect to see a GP within two days of asking for an appointment; now, more than 87 per cent. of patients say they see their GP within 48 hours.

John Horam: Appointments are an important issue because they are the first point of access between doctor and patient. In most circumstances, it is sensible for a person to make a phone call, and they will then get an appointment for that day or the following day. However, patients who telephone are increasingly finding that they are placed behind others who make appointments through the internet. As a consequence, elderly people who do not have a computer are at a disadvantage in getting appointments. Is the Minister aware of this, and what can be done about it?

Ben Bradshaw: I am certainly aware that some GP practices are introducing the option to book appointments electronically, and I welcome that as it provides a greater range of means by which people can make appointments; the complaint has often been made in the past that is rather difficult at some surgeries to make appointments via the telephone. However, the hon. Gentleman is right to highlight the potential danger of people who do not have access to the internet, or who do not use e-mail and rely on the telephone, being disadvantaged. I hope that GP surgeries and primary care trusts will do what they can to ensure that that does not happen.

Andrew Lansley: Can the Minister explain why the GP-patient survey said that 87 per cent. of those asked whether they were able to get through to their surgery on the phone said yes, but in a report published by the Healthcare Commission just a couple of months ago on urgent care, the patient experience survey found that 55 per cent. of people always or sometimes had a problem getting through to their GP practice or health centre on the telephone. Why is there a discrepancy between those two results?

Ben Bradshaw: If the hon. Gentleman will bear with me, I will come on to deal with the discrepancies that have emerged between those two surveys and the Healthcare Commission report.

Howard Stoate: In some parts of the country there is still access to GP surgeries via 0844 numbers, and I consider that to be an unfair tax on those patients who have to pay a higher charge to get through to their GPand where the GP effectively revenue-shares with the phone company, perhaps through how they pay for the phone system. This practice damages access, and I would like to learn what the Government might do to stop it, as it disadvantages patients, particularly in poorer areas.

Ben Bradshaw: I can reassure my hon. Friend that we are looking closely at this. We have repeated on a number of occasions that the public should not be charged more than the cost of a local call for contacting their GP surgery. Some surgeries have introduced these more expensive phone systems, but we are looking at whether we can introduce a system where that would not be the case without disadvantaging surgeries.

Michael Ancram: I wrote to the Minister's Department on the following matter in the summer. We are all keen for access to primary care to be encouraged and promoted, and we are also keen to encourage people to go to their GPs. However, a pharmacy White Paper is currently out for consultation, and for an area such as my constituency unless the first option outlined in it is adopted, which is the option of no change, it will be less likely that people will go to their GPs and more difficult, particularly for elderly people, to obtain the prescriptions they get at present from their dispensing doctors. Will the Minister take into account the fact that if we are serious about encouraging better access to primary care, moving in a direction other than that proposed in the first option will severely damage that aim?

Ben Bradshaw: I reassure the right hon. and learned Gentleman that we are listening very carefully to the representations that he and other Members have made on dispensing GPs. No decisions have been made yet, but we recognise the value in their work that he describes. At the same time, we want pharmacies and pharmacists to play a greater role in the provision of primary care and we need to address some of the distortions that have been in the market for rather too long.
	Many of the improvements that I described a moment ago have resulted from the much, and unfairly, maligned new GP contract. The contract was vital to prevent the haemorrhaging of GPs from the service, but that does not mean that it cannot be improved. Since its inception we have been improving it in relation to the quality of service from GPs and value for money for the taxpayer.
	The UK's almost unique system of family doctors is envied throughout the world. Most of us need and expect our GPs to be there for us when we need them, but in repeated patient and other public surveys the public have told us that they do not always find it as easy as it should be to see a GP quickly or make an appointment in advance and at a time that suits them. That is why the Prime Minister, when he took over just over a year ago, said that he wanted at least half of GP surgeries opening in the evenings and at weekends. Earlier this week we announced that that target had been met three months early.

David Drew: If my hon. Friend examines the matter carefully, he will see that Gloucestershire sits alongside two other authorities in not having negotiated any improvements in GP access so far. I am assured by my primary care trust that that is historical data and that a lot of practices have now come on board, but will he ensure that there is not a huge disparity across GP practices? They should all offer some out-of-hours provision. Although many do so, the problem is how it has been reported. It was a bit of a shock to see that not one practice in Gloucestershire could qualify as part of the long-awaited improvement.

Ben Bradshaw: My hon. Friend is absolutely right to draw attention to PCTs' so far variable performance in delivering on the target that more than 50 per cent. of GP practices should offer evening or weekend openings. It must be frustrating for him, as a Gloucestershire Member of Parliament, to note that his is one of the areas that still has some catching up to do. I am confident that Gloucestershire will catch up and that every strategic health authority in the country will hit the target by December.
	Of course, the more GP surgeries that offer extended hours, and the more patients decide they like them and vote with their feet, the more likely it is that there will be a snowball effect. In that case, probably far more than 50 per cent. of surgeries in most areas will end up offering extended hours.

Stewart Jackson: Despite the Minister's words, does he not understand the cynicism that many general practitioners will have about the policy of getting rid of the minimum practice income guarantee? Some will feel that that means a move towards a capitation-based, quantitative approach to family primary care rather than a quality-based approach. The real effect will be to close many small surgeries up and down the country.

Ben Bradshaw: No, I do not accept that. I think that the minimum practice income guarantee is one area of consensus in the House, and I shall say a little more about it in a moment. I welcome the fact that the British Medical Association has now signed up in principle to phasing it out, and we want to work with the BMA to ensure that we do that in a way that does not have the impact that the hon. Gentleman describes. The very problem with the guarantee is that it does not reward performance and quality. It makes a significant proportion of payments based on what has historically been paid, and I do not believe that anybody in 2008 thinks that that is the right way forward.

Andrew Lansley: The Minister will no doubt have seen that last week  GP magazine reported the Department's director of the GP access programme as saying that one option that the Department was considering was to replace the directed enhanced service for extended opening hours with a local enhanced service. Can he confirm that that is one of the options that the Department is considering, and that in effect it would bring us to the situation that should have obtained under the contract introduced in 2004?

Ben Bradshaw: No, I cannot comment on those remarks. I can say that we would not want to do anything that was in danger of reversing the marked and welcome progress that has been made on extended hours over recent months.

Norman Lamb: The Minister says that he cannot comment, but is he saying that the report is not true? Do we face another change, on top of the one that was introduced earlier this year?

Ben Bradshaw: If it would help the hon. Gentleman and the hon. Member for South Cambridgeshire (Mr. Lansley), I shall write to them with clarification on the matter.

Peter Bone: The Minister has been extremely gracious in accepting so many interventions. Before he leaves the issue of getting access to a GP within 48 hours, I want to ask him about something that happened in my constituency. A rather poorly elderly lady went early in the morning to get an appointment at the doctor's surgery, only to be told that it was full for that day. When she asked whether she could have an appointment for the next day, she was told, No, you have to come back and try again tomorrow. Presumably that did not register as her not being able to get an appointment within 48 hours, and surely that cannot be the way in which the Government want GP access to operate.

Ben Bradshaw: No, that would not comply with the standard that someone should be able to see a GP within 48 hours. Some surgeries operate a walk-in, non-appointment service, whereas others offer appointments only. However, if someone is not able to see their GP within 48 hours, that would not comply with the current standards. That lady would, therefore, have every right, aided by her able Member of Parliament, I am sure, to complain to the practice concerned and to the primary care trust.
	The people who are taking advantage of these new extended hours are not the people whom the Leader of the Opposition recently described, so disparagingly, as executives who
	need some jabs for a business trip to India.
	Neither are they the people whom some doctors' leaders have described as the worried well. They are the hard-working people who pay for the national health service, and they welcome the fact that they do not have to take time off work any more, in some cases losing wages as a result, just to see a doctor. The new evening and weekend opening hours are proving extremely popular with the public and with the doctors, nurses and other practice staff who are implementing them. I hope that the Conservative party will soon perform another U-turn and abandon its pledge to reverse evening and weekend openingperhaps the hon. Member for South Cambridgeshire will assure us now that it will abandon its pledge to reverse extended opening.

Andrew Lansley: The Minister will doubtless be aware that I will have an opportunity to say something after he has finished, but may I ask him a question now? Has he seen the report on extending opening in this week's  Pulse? It says that its survey of 398 GPs found that
	only 37 per cent. of those attending are working professionals.
	So, the hours are not necessarily being used by people who are in work, and that is what one would have expected. He must know from his own patients survey that the people who most wanted to be able to attend on a Saturday morning were the elderly, not those who are in work. Of course we can respond to patient choice, and to do so is Conservative policy, but we need to be aware who is seeking this system.

Ben Bradshaw: That was exactly the point that I was making. I was citing the suggestion by the right hon. Member for Witney (Mr. Cameron) that the only people who would use extended hours were yuppies getting their jabs before going to Asia, and making the point that a cross-section of patients are benefiting from these hours. This week, I visited a surgery in west London that has introduced extended opening, where I was told that the patient profile of the people using the service was almost exactly the same as the surgery's overall patient profile. It included not only people who welcomed the fact that they could attend before or after work on a week day, but elderly people, who liked the fact that the surgery was quieter, and parents, particularly mothers, who found that they could use the evening openingtheir child care arrangements were looked after because their partner, husband or spouse was already home. We should not be sniffy about the fact that extended opening is being used and welcomed by a cross-section of patients, because that is exactly why the Government introduced it. I hope that the Opposition will abandon their pledge to reserve it.
	Helping patients to fit a doctor's appointment into their busy lives does not just mean making available evening or weekend appointments; it also means patients being able to be seen quickly and to book appointments ahead. Some of the media today have said that the Healthcare Commission's report shows that just 31 per cent. of primary care trusts are giving patients an appointment within 48 hours. That is not correct. The Healthcare Commission's own patient survey and the much larger national GP patient survey, which questions 5 million patients, both show the same thing: last year, 87 per cent. of patients said that they could see their GP within two working days of asking for an appointment. That is a further improvement on the year before.
	The Healthcare Commission has its own separate measurement to judge how effectively primary care trusts are performing. It is that far more stringent measurement that has led to some of today's misleading headlines. While 87 per cent. is good, it is not good enough. Every patient should be able to see their GP within 48 hours. If any of the hon. Members present, or their constituents, think that local GPs are not providing that service, they should take the matter up with their local primary care trust.

Norman Lamb: The Minister referred to the fact that the assessment by the Healthcare Commission is much more stringent, and I have read the relevant section of the report. None the less, the results are alarming, suggesting that patients often cannot get an appointment within the defined period. When the surveys do their mystery shopping, they make three calls, because in real life people often cannot make specific times, especially if they are working. The commission report should therefore give rise to considerable concern and demonstrates how much further we still have to go.

Ben Bradshaw: I agree, and I wish to put on record my admiration and respect for the work of the Healthcare Commission. We established that independent health watchdog and its work has helped us to drive up standards across the NHS. It is also right to highlight in its report the relatively weak performance at primary care trust level. There has been significant improvement across the NHS, as Sir Ian Kennedy, the chairman of the commission acknowledged, both in his foreword to the report and in his media interviews, but acute hospital trusts are performing much more strongly than primary care trusts. That is partly because primary care trusts were massively reorganised only two or three years ago and have been settling down since. There has been improvement, but the Healthcare Commission is right to focus the criticisms in its report towards primary care trusts, and especially their management of GPs.

Andrew Lansley: It is important to be clear about what the Healthcare Commission is saying. Will the Minister therefore agree that it was unhelpful for the Secretary of State to wander around studios this morning insinuatingand sometimes even statingthat there was a difference between the commission's survey and the Department's, because the latter asked about the chance of seeing a doctor within 48 hours, and the former asked about the chance of seeing your doctor? That is irrelevant. In fact, the Healthcare Commission incorporated the result of the GP patient survey fully into the measure that it has published. In that sense, what the Minister has said is true, and not what the Secretary of State said.

Ben Bradshaw: It would be unwise for me to comment on media interviews that I did not hear or see. I do not think that there is any difference between us and the Healthcare Commission on the surveys. Indeed, the commission used our survey as part of its report. The difference, as the commission acknowledged, comes in its interpretation of some of the data, which has led to headlines claiming that two thirds of people cannot see a GP within 48 hours, so millions of people are deprived of access to GPsto misquote the splash in  The Daily Telegraph today. That is not the case, and the Healthcare Commission has been happy to put it on record that that is not its view.

Peter Bone: What the report actually said was that two thirds of primary care trusts were failing to get everyone in their area seen within 48 hours. If that is the case, it is quite a failure to meet the Government's target.

Ben Bradshaw: It is not a target, but a standard; let us get our terminology right. The hon. Gentleman is right, but it would be wrong to imply from that information that millions of people were being deprived of access to a GPthat is not the caseor to give the impression that the vast majority of people in both surveys were unable to do so: 86 or 87 per cent. said that they could get to see their GP within 48 hours.

Andrew Lansley: I am sorry to intervene again, but if we are in the business of clarifying we should clarify properly. There are two surveys, one of which is the primary care access survey conducted by the Department through primary care trusts. The other is the GP-patient survey conducted by Ipsos MORI. That survey says that 87 per cent. of patients say that they can access a doctor within 48 hours. The national primary care access survey says that 98.93 per cent. of patients can access a doctor within 48 hours. Part of the issue is how the Healthcare Commission has constructed its measure. It has done so partly to incentivise improvement on the patient access survey, and partly to penalise the gap between the two surveys, which on average across the country is approaching 12 per cent. The measure has taken some PCTs below 80 per cent. overall achievementbelow a mark of 80which means that they are held not to have achieved the level. I know that that is complicated, but it does not mean that it is true that the two surveys deliver the same result.

Ben Bradshaw: We are dancing on the head of a pin. I agree completely with what the hon. Gentleman just said, and I am not quite sure what point he was trying to make.
	One way in which we have achieved the improvement in GP access is using incentives in the new contract. An ever-increasing proportion of the payments made to GPs is based on a patient's ability to get an appointment within 48 hours and to book appointments ahead. More than 38 million is now available through the quality and outcomes framework to award those practices whose patients are highly satisfied with the speed and efficiency of the appointments system.
	Providing incentives for practices to open for longer, and making it easier to see a GP quickly and to book appointments ahead, are only part of the story. We are also expanding primary care through new and additional GP practices. We have already replaced and refurbished nearly 3,000 GP premises and built more than 650 one-stop primary care centres. We have invested nearly 1.5 billion in primary and community care facilities since 2003 under the LIFTlocal improvement finance trustinitiative.
	In order further to improve access to GP services and to tackle some of the persistent health inequalities, we need to do more. We are investing 500 million over the next three years to provide a new GP-led health centre in every primary care trust in the country. Any member of the public, regardless of which local GP practice they are registered at, will be able to walk in and use those services or book an appointment in advance. Every centre will be open from 8 o'clock in the morning to 8 o'clock in the evening, seven days a week, 52 weeks a year.

Tony Baldry: The Minister has talked about carrots and incentives for GPs to improve access, and I am sure that we all welcome that, as it is good news. However, there is one thing that I am at a complete loss to understand. In the whole area covered by the Oxfordshire PCT there will be just one Darzi centre in one bit of the county, so how will that help everyone else all over the rest of Oxfordshire? Would it not be better to put the money that will go into that Darzi centre into the general pot of incentives and carrots to help all GPs improve their services? Effectively, what will happen is that one Darzi centre in one bit of the county will be competing with the GP practices there, while the rest of the county will not benefit at all from the centre. I do not understand the public policy imperative of all that. It is very confusing.

Ben Bradshaw: What happens in Oxfordshire is a matter for Oxfordshire PCT. The hon. Gentleman might want to make representations to the PCT. If he does not want the new walk-in centre in his constituency, in Banbury, perhaps the trust would be better off putting it in Oxford, where students could benefit from it.
	As I said earlier, one thing that has come top of the public's concerns on the further improvements that they want in the health service is the ability to see a GP at a time that is more convenient to them. As we have discussed already, more than half of GP surgeries now offer appointments in the evenings and at weekends, but it may be that only half or 60 per cent. of GPs in Oxfordshire do so. It is right that a service should be provided so that people whose surgeries are not open in the evenings or at weekends, or at a time that is more convenient for them, can make use of them on a Saturday or Sunday or a weekday evening. I must tell the hon. Gentleman that those facilities that are already up and running are incredibly popular.
	Earlier this year, the proposals were subject to a campaign of opposition led by the British Medical Association. I am afraid that that campaign was supported by both the Conservatives and Liberal Democrats. The claim was that the proposals posed a threat to existing GP services and would lead to the wholesale closure of GP practices. I believe that both Opposition parties are pledged to scrap them, and that is another area in which I confidently predict U-turns by them.

Norman Lamb: What we opposed was the central imposition on every PCT. The Minister responded to the intervention from the hon. Member for Banbury (Tony Baldry) by saying that the decision was up to each PCT, but that is not the case. It was imposed from Whitehall. Will he confirm that every PCT had no choice but to go along with the decision, and also that the time scale was very tight?

Ben Bradshaw: I do not know whether the hon. Gentleman has misinterpreted my remarks accidentally or deliberately, but I said that the decision on the location was entirely up to Oxfordshire PCT. He is entirely right to say that we are insisting that every PCT in England establishes one of the new facilities, but I have never met anyone who is 100 per cent. satisfied as to the current level of access to general practice in their area. The new facilities will be a big improvement, and as I said, the ones that have been set up already are extremely popular.

Philip Hollobone: One big concern in the opposition to the proposals was the cost per patient visit of the new centres. My own GP, Dr. John Fitton of the Dryland surgery in Kettering, has produced evidence that that cost in his surgery is far less than in the new Darzi centre that might be established in the town. Will the Minister satisfy the House that the cost per patient visit in the new centres will not be far larger than in current GP surgeries?

Ben Bradshaw: I shall be happy to look at the figures if the hon. Gentleman would like to provide them, but it will be the responsibility of his local PCT to ensure that the services are provided effectively and efficiently, and that they represent good value for the taxpayer.

Stewart Jackson: Will the Minister give way?

Ben Bradshaw: I will, but then I really must make some progress.

Stewart Jackson: The Minister is being very generous, but is he aware of the survey done last month by the company CACI, which helps big commercial organisations with mapping their retail operations across the country? It found that a significant number of PCTs do not have suitable sites for Darzi centres, and many PCTs were quoted as saying that the centres would lead to an inefficient and overlapping network of services. The lack of a major centre plan from the centre means that a lot of public money would surely be wasted if the Darzi centres were imposed on PCTs.

Ben Bradshaw: One moment we are criticised for having too much of a strategic plan from the centre, and the next for not having one at all. By referring to Darzi centres, the hon. Gentleman is confusing his terminology in the same way that the hon. Member for Banbury did. He may be thinking of the polyclinic model, which is certainly part of the likely emerging health landscape in London but which I suspect is not something that most areas of the country will pursue.
	The new centres will give people the flexibility to visit a doctor at almost any time of the week, at a time that is convenient to them, while remaining registered with their own GP. The benefits will be immense, especially for people who commute or spend long periods away from home, for students who want to remain registered with their doctor at home but who want access to health care where they are studying, or simply for people whose own GP does not open in the evenings or at weekends.
	As well as the new GP-led health centres in every area, and in order to help tackle further health inequalities, the NHS is establishing 112 new GP practices in the areas of greatest need and where there are fewest GPs per head of population. The Jubilee line heads from here in Westminster to Canning Town in east London, and the average life expectancy of people whose homes pass overhead along the line falls by a year for each of the seven stops along the way. The ratio of GPs to population also falls dramatically. Based in the community, the GP's surgery is in the front line in improving health and tackling inequalities.
	Increasing the number of primary care clinicians in an area can therefore be the single most cost-effective way of improving the health of that population. Yet the most deprived areasthose most affected by poverty, an ageing population and rising levels of obesityare usually the very ones that have the fewest GPs, so funding new practices in the areas of greatest need will have a decisive impact. They will help remove long-standing inequities in health provision in England and improve health outcomes for the local population. More practices will also mean greater choice for local people.
	I mentioned earlier that we were always looking for ways of improving GP services. One of the aspects of the existing contract that has come in for criticism, in my view justifiably, has been the minimum practice income guarantee. It has protected the historic income of GP practices that would otherwise have lost out when the new contract was introduced in 2004. It was right for that time, but as GP pay and conditions have improved, we believe that it has outlived its purpose. It reduces the incentives for popular GPs to take on more patients, thus constraining real patient choice, and it is not closely enough related to GP performance.
	We are very pleased that earlier this week the British Medical Association agreed that the time had come to end GPs' reliance on that source of income. On Tuesday we announced that in 2009-10 we would take the first step towards abolishing the MPIG.

Andrew Lansley: Will the Minister give way?

Ben Bradshaw: I will just finish the point. As we take those steps, practices will be able to offer improved services to their patients. This includes better access to those services. I give way to the right hon. Gentleman.

Andrew Lansley: Not right honourable.

Peter Bone: Not yet.

Andrew Lansley: Well, sometimes right, sometimes honourable.
	We have discussed the MPIG in the past. As the Minister says, it was always intended that it would disappear over time as the award to GPs was focused on the quality and outcomes framework and weighted capitation. Given that we are moving in that direction, does it not also make sense to ensure that as GP practices lose income guarantees, so the GP-led health centres that he is talking about should not have income guarantees built into their contracts? Then at least whoever wishes to provide a new practice in the form that he describes does so on the same basis as existing GPs.

Ben Bradshaw: I certainly agree with the hon. Gentleman that there should be a level playing field throughout primary care. That is what the phasing out of the MPIG will at long last help us deliver.
	The reform of the MPIG will, as I have already said, help improve patient choice. Everyone in England can now choose which hospital to go to for their operation. We want people to have the same level of choice when it comes to their GP. The NHS Choices website provides patients with ever-more detailed information about their local GP practice, the services that it provides and its opening hours, and even what fellow patients think of the practice. With these important reforms and with people exercising choice, GPs will be more accurately rewarded for providing top-quality services, and that will help drive up standards even further.
	The quality and outcomes framework, which links GPs' pay to the health outcomes that they deliver, has also brought major benefits for patients. It has significantly improved the way in which GP practices record risk factors such as high blood pressure or smoking. This focuses attention not just on helping the sick to get well but on how to help people lead a more healthy lifestyle. This week we also agreed improvements with the BMA to the quality and outcomes framework. The new agreement will see 80 million relocated to reward practices delivering a range of new services for their patients, including helping to prevent cardiovascular disease in people with high blood pressure, improving advice and choice on contraception, a new indicator for depression to make sure that treatment is not stopped too soon, improvements for chronic kidney diseases, diabetes and chronic lung disease and improved drug treatment for people with heart failure.

Norman Lamb: In its report a week ago, the Public Accounts Committee indicated that there was not yet much evidence of any significant improvement in health inequalities as a result of the use of the QOF. When does the Minister think that evidence will be available that will demonstrate that the QOF is working to create a healthier population?

Ben Bradshaw: Given the time lag in terms of the impacts on health outcomes, it is inevitable that the evidence will take some time to come through, but the hon. Gentleman might note the advances we are already making on mortality rates for some of the long-term conditions and killer diseases that have disproportionately affected people from the lower socio-economic groups. We are already making progress in that regard and GPs are firmly convinced that the QOF has helped. The more we change and reform the framework in the way I have just outlined, the more we will tackle the inequalities that he and I and all Members want tackled.
	The new agreement also introduces valuable improvements to the framework. It recognises and rewards high-quality patient care and has a stronger focus on health outcomes. As well as rewarding and providing incentives for good clinical outcomes, we want to ensure that patients feel they have been treated with courtesy and respect. That is why, earlier this year, we announced in the next stage review that a greater proportion of the incentive payments made to GPs in the future will be based on how good the public feel the service provided was, based on our comprehensive annual patient survey. The 2008-09 patient survey will provide even more information about whether practices are getting the basics right. Do patients have the option of a telephone consultation? Are they listened to and treated with respect? What is their experience of out-of-hours services? What GPs are paid will directly reflect the standard of accessibility and convenience that they offer.
	The Government are overseeing the greatest expansion in primary care since the creation of the health service 60 years ago. We are investing in new practices and new services. We are putting patients at the centre of health care planning. We are giving patients a greater choice of when and how they see a GP. That is not an alternative to existing primary care provision, and it will not undermine GP practices; it is an addition to existing services. Patients now enjoy an unprecedented quality of service. Their views are translated into local action and their desire for a more convenient and accessible high-quality NHS is being brought to life.
	Primary care is the cornerstone of the national health service. It is where we all turn first when we or our families need help. I am pleased to report that in its 60th year primary care is in excellent health. With continued investment and reform under this Government, it will get better still.

Andrew Lansley: I am glad that the Government have chosen to discuss access to primary care this afternoon. It was timely given that the Healthcare Commission reported this morning, although from the Government's point of view they might have checked what the commission said before choosing to hold a debate on the day it reported. However, from our point of view we are pleased that they did.
	The debate follows two debates in Opposition time during this Sessionon family doctor services and on the Government's polyclinic plansboth of which gave us substantial opportunities to set out how we feel about general practice's central contribution to health care, how we value general practice and how we hope to support and develop it in the future. I shall not take up as much time as the Minister, and will try to limit my speech, as this was the chance for him to set out some things in detail.

Ben Bradshaw: rose

Andrew Lansley: The Minister generously gave way often, so I shall of course give way to him.

Ben Bradshaw: That is the very point I wanted to make: half my time was taken by interventions.

Andrew Lansley: I did not mean to be critical. The Minister took many interventions, which allows me to avoid having to say some things I would otherwise have had to say.

Anne Moffat: I have to get a flight to Scotland tonight.

Andrew Lansley: The hon. Lady is in the hands of the Chair, who determines matters such as the timing of debates. If the Chair felt that I were being excessive in the use of time, I have no doubt that he would stop me.
	I have never seen a better description of the central role of primary care than that offered by Barbara Starfield, professor of health care management at Johns Hopkins university in America. In one way, it is surprising that an American academic can understand it, but I suspect that she can see it, not least because there is often a lack of such primary care infrastructure in America compared with the UK, and there is envy of our primary care system, particularly our family community physician service. She said:
	Primary care deals with most health problems for most people most of the time. Its priorities are to be accessible as health needs arise; to focus on individuals over the long term; to offer comprehensive care for all common problems; and to coordinate services when care from elsewhere is needed.
	There is lots of evidence that a good relationship with a freely chosen primary-care doctor, preferably over several years, is associated with better care, more appropriate care, better health, and much lower health costs.
	All those things are true, but as hon. Members will recall from previous debates, defining primary care in those terms also helps us to identify some of the central problems of the Government's approach to primary care.
	Primary and secondary care are too often separated from each other. Family doctorscommunity physicianshave too little control over care. They do not have enough ability to manage the care for their patients, so the thing we are all looking formore integrated care, focused on the needs of patientscannot be delivered.
	People's relationship with their GP is being undermined by the Government's Martini strategyAny time, any place, anywhere. From the Government's point of view, it is good enough that the patient is seen by somebody, whereas from the public's point of view, it often matters a great deal who one is seen by. Awareness of that seems to have disappeared. The atomisation of primary care in the Government's hands is one of the central problems. It is not that the Government think primary care access unimportant, but the way they are going about it is undermining one of the most important aspects of primary care.
	The Minister raised a number of subjects, and I shall mention one at the outset. He said at the start that he would illustrate how, in primary care, the patient voice was being listened to, but I did not detect that in anything that he subsequently said. Apart from the fact that a lot of the Government's thinking seems to have been dictated by some of the results from the GP patient survey, the patient voice as such, in any qualitative sense, seems to have disappeared from primary care. Patients are supposed to be able to exercise choice. If the Minister really wants to know what we most want to achieve, we want to achieve a situation where patients have choice and voice, which has not happened.
	I have been at this Dispatch Box talking about health for my party long enough to recall responding to a statement by the Secretary of State in January 2006 on the community White Paper called Our health, our care, our say. One of the things in that document, which we supported, was the intention that patients should be able to exercise greater choice about their general practitioner; but it has not happened.
	For example, where is the incentive to take on new patients? This week, the Minister said for the first time that the announcement about increasing the global sum in relation to the correction factor means that there should be a greater incentive to take on new patients, but it has taken nearly three years to get to that point. In January 2006, it was stated that we could expect something on the expanding practice allowance, but it has not happened. The same promise was repeated in the next stages review published in June 2008, as though two and a half years had just passed by and nothing had been done inside Government.
	The Government promised, in January 2006, that they would stop general practices being open but full. It did not happen. What happened? The promise was repeated in the next stages review: We are going to do it now. Well, two and half years have gone by.
	The Government said, in January 2006, that walk-in centres would be reviewed. I was listening out for walk-in centres. They were not mentioned. If you had asked me, Mr. Deputy Speaker, before the Government went down the route of polyclinics, What actually should Government be doing? this is what we would have saidI think that the Liberal Democrats probably agree with this. First, encourage and incentivise more practices in under-doctored areas, and make sure that practices working in the most deprived communities have genuine incentives, rather than perverse incentives, to do so. Across the country, ensure that people can maintain their registration with the practice of their choiceand that they have greater choice. There is a need and a wish for patients to be able to access care on a more discretionary basis, not always having to go to their own practice. Actually, that was what walk-in centres were all about.
	The logical thing to do is not to set up new polyclinics, the purpose of which is not to be open from 8 am to 8 pm seven days a week, but to look at the walk-in centre pilots and ask how we can make walk-in centres do that job in the places where they are necessary. My hon. Friend the Member for Banbury (Tony Baldry) has left the Chamber, but he made a good point. The Government have told primary care trusts to do it, and they are doing so in places, mostly of their choosing, that do not necessarily relate to that need.
	There may well be a need for a walk-in centre in Oxfordperhaps there is such a centrebut in that city as, for my part, in Cambridge, where there are lots of tourists, students and people who, because they are commuters, sometimes find it difficult to access their local GP, the idea of a walk-in centre is a perfectly reasonable one. In 2006, the Government said that they would review walk-in centres and create the right incentives across primary care to look after unregistered patients, but they did not conduct such a review. They said that they would allow people to register near their work, rather than their home, but they have not done so. I am afraid that the things that the Government said that they would do have not been done, so the House will forgive us if we are less than confident about the Government's intentions.
	None of this has allowed patient choice to occur, but neither has patient voice had an impact on primary care. Community health councils have been abolished in England. Patients forums have been abolished in England, and it is very difficult to establish what is happening on local involvement networks in many places. The people who are most able and willing to support serious qualitative input by the public and patients who wish to engage with the quality of their health care have found that their contribution has been so disparaged and undermined by constant Government changes that they have walked away. We have to change that.

Anne Moffat: rose

Andrew Lansley: I hope that the hon. Lady will say that she will support Conservative proposals for an independent, empowered health watch in every part of the country, including a national consumer voice in health care.

Anne Moffat: Is my right, or not, hon. Friend[Hon. Members: He is not the hon. Lady's friend.] Is the hon. Gentleman stating that his party's manifesto will reintroduce all those quangos?

Andrew Lansley: Just a few weeks ago, I published a summary of our health care policies, and it is clear that LINks should be converted to health watch locally. Local authorities, such as Kent county council, have set out to create precisely that kind of powerful consumer voice in England, embracing health and social care. A previous Secretary of State commissioned a review of regulation in the health care sector from Lord Currie of Marylebone, who as the hon. Lady will know, was previously a Labour Member in the House of Lords. He recommended to the Government that there should be a national consumer voice in health care, but the Government have effectively abolished that voice, and it has disappeared.
	Instead of talking about patients very much, the Minister talked about the GP survey, which led Ministers to the conclusion that, because just less than 10 per cent. of respondents were dissatisfied with their surgery's opening hours, because their surgery did not open in the evening or on Saturday, they needed to tell GPs what to do. The Minister keeps asking whether we are going to reverse his policy, and the answer is yes, we are going to do so. We are not going to tell GPs what to do. We are going to make them far more accountable to patients, and to give patients much greater power. We are going to hold GPs to account for the quality and outcomes that they deliver. There is something utterly perverse about the Government's belief that quality and outcomes are the basis on which GPs should be measured and rewarded, but then try to dictate in detailsometimes in absurd detailhow GPs should go about their processes, rather than measuring their performance and rewarding them on the quality and outcomes of what they do.

Ben Bradshaw: How would the hon. Gentleman give this new power to patients, when both he and the right hon. Member for Witney (Mr. Cameron) have said that they would give the BMA a veto over opening hours?

Andrew Lansley: Those words have never passed my lips or those of my right hon. Friend. The focus is on patient choice. There is something absurd about the entire argument. The negotiation of the GP contract in 2004 was the moment when GPs said, If we offered Saturday morning surgeries up to now, we will stop doing so. If the primary care trust wants us to do Saturday morning surgeries, the contract states that the PCT will commission that as a local enhanced service. Most PCTs did not do so.
	We discussed the matter in February this year. The Secretary of State and the Minister were in a stand-up row with the BMA about it, quite unnecessarily. The Secretary of State admitted that he did not know how many primary care trusts commission, through their local enhanced service, extended GP opening hours. The Minister will not say whether that is happening or not, but we will probably end up going back to a local enhanced service in order to do it on a locally determined basis, which is precisely where PCTs should have been in the first place. The present situation is outrageous. The relationship between Government and general practitioners has been damaged to a remarkable and deeply unwelcome degree.
	There is much in the GP patient survey that the Government seem to have ignored by focusing on extended opening hours and nothing else. Look, for example, at patients wanting to book ahead. The fact that almost 10 per cent. of patients in the survey wanted extended opening hours was the basis upon which the Government created a raft of policy. We know that almost exactly the same number, just under 10 per cent. of those in the survey, wanted to be able to book ahead for their appointments but were unable to do so. Why? That is a consequence of the Government having introduced their 48-hour target, rather than GPs being able to manage their appointments system in the way in which they want.
	So we have ended up with the Government creating unhappy patients, in large measure, by introducing a target. Another part of the survey revealed unhappy patients as a consequence of the Government's own contract. They ignore one and blame GPs for the other, when clearly it was the Government's fault. It is an outrageous abuse of the Government's position to blame GPs, as they have done. I do not have to be a friend of the BMA to defend GPs against the way in which the Government have behaved towards them.
	The Minister said that changes are needed to the quality and outcomes framework. There are benefits in shifting GP remuneration towards the global sum and the quality and outcomes framework instead of the correction factor. It is important that the QOF responds to evidence about what is likely to deliver quality. When the Minister responds, perhaps he can explain this. The Darzi review in June stated:
	We will introduce a new strategy for developing the Quality and Outcomes Framework which will include an independent and transparent process for developing and reviewing indicators.
	The expert panel for 2008-09 recommended that there should be a new indicator for osteoporosis and for peripheral arterial disease. The Government did not do that in 2008-09, because they wanted to focus all the points on their extended opening hoursdirected enhanced services. For 2009-10, the opportunity existed to introduce a new indicator and the expert panel had told them to do it, but it is not among the clinical indicators that have been added. Effort and money were spent on delivering expert advice on the QOF, and the Government have ignored it. Perhaps the Minister will explain that.
	GP commissioning is central to our policy, although I will not explain at length why it is central. When the Minister spoke about devolving decisions, he talked about devolving decisions to primary care trusts. Devolving decisions to GPs has disappeared from the lexicon of Ministers, as it has from most of the next stage reviews that were published over the summer. We know from the Audit Commission's work that was published in June that practice-based commissioning has stalled. Most GPs feel that their primary care trust does not support it, that they do not receive any management support for it and that they do not have the opportunity to do anything. As a consequence, very few GPs have been able to commission any new services.
	I know where we standwe want to create proper, powerful GP commissioning as a basis. The integral strength of primary care, in being able to manage the care of patients by someone with whom they have a relationship, points directly to that conclusion. Ministers used to talk about practice-based commissioningwhen Tony Blair talked about reform of the national health service, practice-based commissioning was one of his key reformsbut it has disappeared. If the Minister is going to talk about primary care when he replies, perhaps he will tell us whether practice-based commissioning is still the Government's policy, because I think that it is disappearing.

Norman Lamb: May I commend to the hon. Gentleman a Liberal Democrat survey of GPs in Norfolk that asked about practice-based commissioning? In answer to the question whether GPs thought practice-based commissioning had improved patient care, just 11 per cent. felt that it had, with only 6 per cent. saying that it had had a considerable impact on their practice. In Norfolk, therefore, practice-based commissioning is simply not happening in most practices, and that is very depressing.

Andrew Lansley: Yes, it is depressing. Indeed, what the hon. Gentleman describes is consistent with what the Audit Commission said in its document earlier this year. It said, understandably, that the few practices where GPs had grabbed hold of practice-based commissioning and were using it creatively tended to be the same ones that had substantial experience of fundholding, so they are responding only now, 11 years later.
	I do not want to go back to fundholding. I want to develop GP commissioning that is relevant and applicable to every GP practice, so that they can all use the kind of freedoms that came with fundholding. More to the point, however, I want to do that within a better accountability framework, in which the PCT's role is that of strategic commissioner, if necessary policing the boundary between commissioning and provision, and in which patients exercise greater choice than under fundholding.
	We are talking about access to primary care, but the Minister did not mention dentistry, as though dentistry in primary care did not exist. If my hon. Friend the Member for Hemel Hempstead (Mike Penning) catches your eye, Mr. Deputy Speaker, I hope that he will have time to say something about dentistry. The Minister did not talk at all about the process of accessing urgent care. However, for many patients, one of the central issues is how they can get hold of somebody. That obviously includes the out-of-hours service, which is, at least in theory, an extension of general practice, out of hours. However, that has not been true of the out-of-hours service since the introduction of the new contract, because the service has been taken away from GPs.
	We know that in many places GPs continue to manage out-of-hours services through co-operatives. My personal experience is that where that happens, GPs and patients locally find that the service still meets more of their objectives. Indeed, I am surprised that the Minister did not speak positively about the benefits of that, since Devon Docs, which operates out of his constituency and which I had the privilege of visiting earlier in the year in Marsh Barton.

Ben Bradshaw: Did you tell me?

Andrew Lansley: Yes, I did. Devon Docs provides a service not only in Devon, but under contract in parts of the north-west, such as St. Helens and Warrington, if my memory serves me correctly.

Anne Moffat: What would the hon. Gentleman do, given the fact that his party destroyed dentistry by privatising it?

Andrew Lansley: I am sorry; I should not have given way. My hon. Friend the Member for Hemel Hempstead will say something about primary care access to dentistry later. I will leave that to him, because I know that he feels strongly about it.
	I do not want to go on about the out-of-hours service in detail, but it is just not good enough for Ministers to treat access between 8 am and 8 pm, five days a weekor even including the weekendas a sufficient answer to the issues that the public have raised. The GP patient survey does not touch on out-of-hours services to find out what patients' experiences are. We need to ensure that GPs feel that the out-of-hours service properly integrates with the service that they provide during the week, and we need to ensure that it is more accessible from the patients' point of view.
	This is all part of an urgent care approach. Interestingly, the Next Stages review documents all over the country are saying that we need to reform access to urgent care, but no one is doing anything about it. My hon. Friend the Member for Hemel Hempstead might add to this later. It is clear that we need to think hard about how people first approach the NHS. If they want to go to a walk-in centre, that is fine. But if they want to pick up the telephone, they often find themselves not really knowing whether to ring NHS Direct, their local GP, a different number for the out-of-hours service, another number for a dental service or 999. They are not sure about any of these things, even in an emergency. In fact, the figures demonstrate that large numbers of people end up ringing 999 when there is not an emergency.
	We need to arrive at a position in which there are just two numbers. If there is an emergency, people should ring 999. If there is not, they should ring another number. Clearly there is work to be done regarding that other number, because I understand, having spoken to Ofcom, that the numbers that we could use are being progressively taken by others across Europe. We have to do this on a Europe-wide basis, and others across Europe are taking the relevant 116 numbers. If we do not get our skates on, the proverbial beach towels will have been laid across all the numbersand we can guess who is doing that.
	Access to primary care is not confined to GP practices. It also includes health visitors. I suppose we all choose to cite numbers selectively to serve our purpose, but it is astonishing that, although the Minister can get up and tell us how many additional practice nurses there are, he will not tell us how many health visitors there are. Health visitors are also instrumental in the process of delivering better health care. Their numbers have been declining: we have seen a 10 per cent. decline in the past three years. We saw 800 health visitors leave the profession in 2006, while only 330 were being trained, even though there were nearly 800 applicants for such posts.
	We need to restore a more universal health visiting service. We, at least, have made it clear that we will make a start by making the resources that were to be used for outreach workers at Sure Start centres available for health visitors who would see mothers when they came home shortly after their babies had been born and see them through those first few weeks. That would be instrumental in delivering an improvement.
	The Minister said that he wanted to improve access to pharmacy. I will not go on at length about pharmacy, but pharmacists are constantly being led up the hill. They were led up the hill over the pharmacy contract. They were told that, instead of the old scheme, they would have a new scheme in which their payment would increasingly be geared to the commissioning of additional services, particularly in the area of public health, such as screening. They are now being told the same thing again, three years after the previous pharmacy contract. That did not happen before, and all their expectations were frustrated. They believe that it will happen again now. At the moment, however, I see no evidence that primary care trusts are launching into this processindeed, quite the opposite.
	If we look at the way in which the Government are approaching the cardiovascular risk assessment programmethis was part of the quality and outcomes framework announcement in relation to the GP contractwe see that it is being geared to be delivered through GP practices. There is good evidence, however, that we do not have the risk-assessment tool available to see what the Government are planning to do, still less the cost-benefit evaluation that supports it. At least, there ought to be an opportunity for pharmacists and pharmacy chains to offer the same service on the same basis. As far as I can see, the information that triggers the risk assessment can be gained in a pharmacy as readily as in a GP practice. If we are talking, as we often are, about men in their 40s and 50s who probably have no reason to be visiting their GP, but find themselves in pharmacies from time to time, this may well be a more convenient and acceptable way for them to access pharmaceutical services.
	Let me move on to polyclinics. The Minister behaves as if these are somehow an accomplished fact. In many places across the country, we are just beginning to realise what the evidence showsmy hon. Friend the Member for Banbury made clear what was happening in his area and it is occurring elsewherewhich is that the choices made by the primary care trusts, entirely at the behest of the Government who told them to have a polyclinic in every area, are entirely inappropriate in the view not only of local GPs, but of local populations.

Norman Lamb: Is not part of the problem the fact that this is being imposed on the basis of such a tight time scale? I am told that, in Norfolk, the estate review for the whole county had not been completed before the instruction came to just get on with producing a polyclinic or a GP-led health centre. That took away the capacity properly to commission and to determine priorities within the county.

Andrew Lansley: I entirely agree. Some GP practices had plans to get together to create more accessible physical accommodation, but because those plans could not be accommodated within the Government's mandatory timetable, they were not able to adapt the polyclinic plan to their particular local circumstances. Yet that is what they should be doing. This is not rocket science; it is very straightforward. If we want more access to outpatient clinics in the community, more access to diagnostic services and to therapists in the communityall of which we doand if the Government want to make 1 million available to a primary care trust to achieve that, the PCT should have that money and be able to decide on the best way of implementing those objectives.
	It is interesting to note what is happening in London. Having had the benefit of Boris's election campaign, which put wind in our sails, we have been campaigning, but it is quite clear that NHS London does not want to do what the Government have told it to do. The Prime Minister said from the Dispatch Box last year that London would have 150 polyclinics and the subsequently published document said that each polyclinic would be a large building with 25 GPs in it and all the rest of that stuff. Now, however, NHS London has arrived at the point where most of what it wants across London is the so-called hub-and-spoke model, which means that most GP practices stay where they are and do what they were doing before. Put into the so-called hub are outpatient clinics, diagnostics and therapistsall perfectly okay from my point of view, but that is not what the Government told London to do. It just shows the poverty of the ideas in the Government's original proposals.

Neil Gerrard: The hon. Gentleman is confusing two different things, as a GP-led health centre is not the same as a polyclinic [Interruption.] Well, let me tell the hon. Gentleman about London, which is a subject that he raised. My PCT is going to be in the first wave of polyclinics. It told me and other MPs in the area very clearly and simply that a polyclinic is not the same thing as a GP-led health centre. Indeed, the GP-led health centre is a completely separate proposition from the hub-and-spoke polyclinic that is being introduced. I do wish that the hon. Gentleman had talked to some people in London before telling us what he thinks is actually happening there.

Andrew Lansley: Well, I do talk to people in London. Indeed, I talked to the chair of the joint health overview and scrutiny committee in Londonand Mary told me exactly what was happening. I do not have them with me now, but I have received written answers from the Minister on the definition of a polyclinic and a GP-led health centreand they are virtually the same, in the Minister's own words.
	My point is that the Darzi report said that there would be 150 polyclinics in London. I hope that we will end up with a small number of polyclinics in places where it makes sense locally, and with a large number of investmentsagain where it makes sense locallyin GP or primary access to diagnostics, therapists and other services that might otherwise be provided in a hospital context. If that happens, it means, frankly, that we have won the argument to the benefit of London. Everywhere else in the country, however, it seems that people are still being told to do something on the basis that it is the same as what is recommended in the Darzi report which was published in London, and even London now appears to be abandoning that. The collapse of the Government's policy seems to be nearly complete.
	I hope that people working in general practice and primary care understand that we value what they do, and that we want to re-empower them by doing away with some of the top-down targets that the Minister spent all his time talking about. We want to give them the support that they need in order to deliver the best possible care for patients. We will make the accountability less to the bureaucracy and less to what the Minister wants them to do, and much more to patients, and we will build that accountability throughout the country.

Neil Gerrard: I have been in the House for 16 years, and if I had to identify a service that I believed to have been transformed during that time, it would be the health service. In fact, that transformation has happened over the last 11 years.
	I remember what primary care in east London was like in the mid-1990s. It was characterised by single-handed GPs working in totally inadequate premises, often houses that had been converted into surgeries. It was characterised by the frequency with which people found it impossible to register with a GP, because virtually none of the GPs had open lists. It was characterised by the fact that both GPs and patients were in absolute despair at what happened when GPs tried to refer patients to secondary care. The patients had to wait months and months for treatments or diagnoses.
	I saw the difference myself earlier this year. I have visited my GP five or six times in the past year, which is more often than I had visited a GP in the previous 20 years. I saw how quickly my GP was able to secure for me the diagnostic test that I needed. The position of 10, 11 or 12 years ago had been completely transformed.
	As for patient choice, in those days there was no choice. People waited. If there was a choice, it was this: they waited or they paid. That is the choice that faced people 10 or 12 years ago. I remember seeing people who were desperate to get treatment. They would say to me, I do not agree with private medicine. I do not like private medicine. What should I do? The alternative was to wait and wait and wait. Now, as a result of the local improvement finance trust programme, I am seeing new health centres with groups of GPs operating in them, and GPs being encouraged to invest.
	A few weeks ago I visited a practice very near my home, where GPs demonstrated the investment that they had been encouraged to make in their premises to deliver better access and better services. They talked to me about the extended hours as well. I am very pleased that 39 of the 47 practices in my local PCT area are now offering those extended hours. I cannot understand for the life of me why anyone should think there was something wrong with that. Certainly none of the GPs to whom I have spoken think that there is anything wrong with it.

Andrew Lansley: As the hon. Gentleman is extolling larger practices and the benefits of extended opening hours and increased access for patients, can he explain why the GP patient survey shows that on all five measuressatisfaction with telephone access, 48-hour access to GPs, advance booking, appointment with a specific GP and satisfaction with opening timesthe performance of small practices with fewer than 2,000 patients was better than the performance of large practices with more than 15,000 patients?

Neil Gerrard: All I can say is that I observe what has happened on the ground. What I observe is that people are able to see their GPs more quickly, that they are seeing them in better premises, and that where GPs are grouped together, they frequently offer better access to patients than single-handed practices. That is not to say that single-handed practices cannot workI can think of examples that work wellbut I remember what it was like when we were almost entirely dependent on such practices.
	For people who have jobs where they are paid hourly, taking time off during the week is not a trivial thing to do. It costs them money. Many people in permanent full-time jobs may be able to have a half-day holiday, but if an hourly paid worker takes half a day off, it costs them half a day's pay.
	There are some issues about extended opening. GPs still have some issues with that. They need to sort them out and they need help with that. Obviously, if they are going to have extended opening hours, they will have to have receptionists and support staff there for longer. That is not always easy, particularly in smaller practices. Extended opening hours benefits patients. It certainly benefits local hospitals as it keeps people from attending accident and emergency when that is not appropriate.
	We still have too many people who are not registered with GPs. In an area such as mine, that is partly because of the nature of the population. There are significant numbers of people there who come from cultures where primary care does not exist, or does not exist in a form that would be recognisable to them.
	Non-registration used to happen because of closed lists and because people found it impossible to find a GP they could register with. Now, with the new GP contracts, the vast majority of my local GPs are opening their lists up and trying to attract patients. It is possible now for everyone to find a GP and to get to see them.

Peter Bone: I am listening carefully to the hon. Gentleman. Does he agree that it could be different in different parts of the country? In my area, which is fast expanding, it is difficult to get on to a GP's list? One has to refer them to the primary care trust to force them on to a particular doctor's list, so I do not think that what he says is necessarily repeated across the country.

Neil Gerrard: That may well be the case. However, what the hon. Gentleman has just described is what I was seeing until relatively recently. Until relatively recently, I would have had to ask the PCT to step in and to ensure that someone got on to a list. However, over the past year or two, I have seen a significant shift on that and many more practices are offering open lists.
	I understand the points that have been raised about people wanting to see their own GP and forming a relationship with them. Of course that is true, but what is also important to many people is that they are able to be seen when they need to be seen. They value that as well as having a relationship.
	There are still issues about appointment systems. I see great variation between one GP practice and another. Some run systems where they meet 48-hour targets and are able to deal with advance bookings. Others do not have systems in place that allow them to do that. A lot of that is about simple administration, getting better administration and getting the practices that are not delivering a proper appointment system to learn from the ones that are.

Stewart Jackson: I am listening to the hon. Gentleman's comments with great care. Obviously, he comes from the perspective of an inner-London constituency. Why is it, if things are so great, that it is only in the 12th year of a Labour Government that the Minister is promising to look at the quality and outcomes framework? If polyclinics or GP-led health centres are such a good idea, why has not the Department of Health decided to have consensus by piloting them in some areas and seeing whether they work first?

Neil Gerrard: There are a number of issues there that I was not talking about, but I will come to the question of polyclinics in a moment. I want to finish my points about the appointments issue. One of the problems is that, when a practice does not have decent systems, is not delivering on appointments and could do so if it improved its administrative systems, PCTs are relatively powerless to do anything about it. They cannot impose systems on GPs. Therefore, when things go wrong, it can sometimes be difficult for the PCT to deal with that. However, we measure the targets on appointments across the whole PCT, even though it does not have direct responsibility for that.
	I agree with some of what the hon. Member for South Cambridgeshire (Mr. Lansley) said about patient involvement, and I think it was a mistake to get rid of the community health councils, but we must be careful about the ways in which patients are involved and the ways in which we listen to patient opinions. In the past few years, I have come across examples where the PCTand in one case the General Medical Councilwas taking action against a GP and patients were protesting and signing petitions and coming to me and saying that that person was being extremely badly treated. In my opinion, the truth was that they were familiar with the standard of treatment they had been getting so they did not realise how appalling it actually was; they thought the GP was a nice person, and he might well have been, but he was not actually delivering much for them. However, just because of that familiarity, they assumed things were okay.
	In terms of polyclinics, I would be absolutely against developments that led to existing GP practices being closed, as we want that relationship between GPs and patients to remain, but I also firmly believe that many tasks that have traditionally been done in hospitals can be moved out and be done efficiently elsewhere, and that one of the models through which that can be achieved is the polyclinic. My PCT will be among the first in London to have a polyclinic. That will be implemented on a hub-and-spoke model and discussions are already taking place as to how that might operate. GPs want to be involved, and it is perfectly possible that there will be a bid to operate that polyclinic from a consortium of local GPs. I would welcome that; I hope it happens, and if it does, I hope that it succeeds. It does primacy care services no good to set up an artificial argument between polyclinic and GP.
	I want to raise a couple of specific points on access to primary care, the first of which relates to the quality and outcomes framework. A number of Members were approached on this by the National Osteoporosis Society, which was disappointed that osteoporosis was not included within that framework. I can understand that; whatever we include, there will always be other people who are disappointed that their particular interest is not there. One issue the society raised, however, was that there should be a new system for reform of the quality and outcomes framework involving the National Institute for Health and Clinical Excellence and patient groups, and that a consultation had been promised in autumn of this year. It was keen to know when that might take place, because it and other interest groups might want to have some input into it. Therefore, I would be grateful if the Minister could give us some information on that.
	In May 2004, the Department of Health launched the consultation, Proposals to Exclude Overseas Visitors from Eligibility to free NHS Primary Medical Services. That consultation exercise had a number of aims, including getting the rules on eligibility for access to primary and secondary care matched and ensuring that failed asylum seekers and unauthorised migrants did not have routine access to NHS primary care. I recognise that this is a complicated and sensitive issue, and that we cannot simply say that anybody can come here as a visitor and have whatever costly treatment they wantalthough I suspect that the most costly treatment would result from visitors accessing secondary rather than primary care, and I also suspect that some of the really costly stuff would result not from failed asylum seekers or unauthorised migrants, but from relatives of people who are already settled here. My concern, and I think that of a lot of health professionals, is the potential effects of denying access to primary care to vulnerable people. It could be argued that a failed asylum seeker should not get medical treatment, but if they have not been removed, it is an immigration problem and should be dealt with by the Home Office, not through the denial of access to medical care.
	No decision on the consultation has been announced, even though it has been promised a number of times. Neither has there yet been even a report on the consultation results. The Department was asked by the Global Health Advocacy Project, under freedom of information legislation, for the results of the submissions that were made to the consultation and a list of those who made them. It released the list but refused to release the actual submissions. Some arguments about that are currently being made to the Information Commissioner, but I shall not pursue them now. On the basis of the list, a lot of the respondents were contacted, so we know what many of them said. It was clear from the responses that health professionals were concerned about the possible consequences of the denial of care.
	Mdecins du Monde UK, which runs a UK clinic, has produced a report pointing out that although GPs themselves might understand the current regulations, administrative staff do not necessarily. That has led to people who should have been treated, such as citizens of other European economic area countries or asylum seekers whose claims had not been determined, being denied treatment. Mdecins du Monde's evidence suggested that service users coming to its clinic had been in the UK for an average of three years, which does not suggest health tourism. It also stated that the vast majority of the visits to the clinic were to do with primary care such as antenatal services rather than expensive, specialist care.
	The real issue is the public health effects of denying access to treatment. People might have infectious diseases or conditions that are cheap to treat if they are caught early and treated by the GP, but if they are left will end up requiring emergency hospital admissions costing far more. If people are barred from access to GPs, they will end up in hard-pressed accident and emergency services.
	As I said, we have not seen the results of the consultation. I hope that the report in  The Observer last Sunday suggesting that the Government would not go ahead with barring access to primary care was right. I fully understand that we cannot have an NHS that provides expensive care free to the rest of the world, but if there is an immigration problem, we should deal with it as such through the Home Office, not by pressurising people to remove themselves by denying them access to medical care, particularly if the consequences are health risks to other people.
	There have been huge improvements in primary care in east London in the past 10 to 12 years. There have been improvement in facilities, in people's ability to access them and in the secondary care that follows on. Referrals to secondary care happen very quickly now so that people can be treated. I do not want that to be marred by a wrong decision about vulnerable people. While they are here in the UK, we should allow them to receive primary care.

Norman Lamb: It is good to follow the hon. Member for Walthamstow (Mr. Gerrard). I agreed with much, but not all, of what he said. He made some important points about key public health concerns and on the basics of decency and humanity towards people who are in this country. I shall be interested to hear the Minister's response.
	I also agreed with the hon. Member for Walthamstow that we must not allow ourselves to drift back to the access to diagnostics and treatment of the 1990s. The Conservatives will not be pleased to hear me say that their judgment that we should remove all targets and have no other mechanism to guarantee access to diagnosis and treatment is dangerous, and could easily lead to waiting times drifting back towards the lengths that we experienced in the 1990s.

Andrew Lansley: I thought it was Liberal Democrat policy to oppose top-down process targets, but the hon. Gentleman seems suddenly to have shifted. My view on patient choice and contracts is that where something is wanted, the primary care trust or the relevant commissioners contract for it to be provided; they do not have a Government target to make it happen.

Norman Lamb: I am grateful to the hon. Gentleman for giving me the opportunity to expand on Liberal Democrat policy. Our policy, which is based on how the system works in Denmark, is to give a personal entitlement to treatment within a defined period of time, which depends on the condition, and where someone does not receive their treatment within that defined period, it is paid for privately. That guarantees access for every citizen, irrespective of their income or wealth. Health economists tell us that in Denmark the approach has resulted in a radical improvement in the efficiency of state hospitals, and not in a great leakage to the private sector. I commend that approach to himperhaps he should re-examine it.  [Interruption.] It is not the patient passport at all, because the treatment is paid for in its entirety. Without any mechanismeither a target or an entitlement to access treatmentthe great danger is that we will drift back towards having much longer waiting times.
	This debate is timely, coming, as it does, on the day when the Healthcare Commission's annual health check report is published. It is worth repeating that we in this country have an immensely valuable network of primary care that we should cherish and build on, and, although each of us has concerns about various aspects of primary care and access to it, many other countries envy enormously our network of primary care.
	The debate is timely, because the Healthcare Commission's chairman, Sir Ian Kennedy, pointed out that one of the key areas highlighted in the report was the need for improvement on GP access. He said:
	Primary care trusts must redouble their efforts in areas such as access to GPs and the provision of choice.
	The reports refers specifically to
	poor performance clustered around major cities.
	The report shows that the worst areas in London, where there has been a complete failure to meet the target, are the inner-city ones, where the need for access is perhaps at its greatest. The performance map for the whole country again shows that the areas of weakness and of failure are almost entirely clustered around the inner cities, where the need is at its greatest. Of particular concern is the situation in north-west and north-east England.
	The report also refers to very significant regional variation, beyond the concentration of failure in cities. It states:
	Six of the eight PCTs in the South East Coast SHA area achieve the access to a GP indicator, compared to only one of the 31 PCTs in the London SHA area.
	There is massive variation in performance. The results are hardly surprising. As Lord Darzi said recently:
	Sadly it turns out that our current GP system has actually led to a larger inequality in the distribution of GPs across the country over the past two decades even as the overall number of GPs has increased.
	The situation is still deteriorating. A Department of Health report earlier this year confirmed that two thirds of the most deprived fifth of PCTs are more than 10 per cent. below the English average for the number of GPs per 100,000 of the population, which is worse than the figures for 2002. In a period that has seen massive increases in investment in the health service, inequality of access to GPsin relation to the number of GPs operating in an areahas worsened. For example, Barking and Dagenham, which is one of the poorest boroughs in the country, has 48.3 GPs per 100,000 of the population, but Devon has 81or nearly double. In areas where need is greatest, access is worst.
	What are the Government doing to redress that imbalance, which is bound to have an effect on health inequalities? Everyone signs up to the need to reduce the inequalities, but some of the things that have happened in the past 10 years are bound to have worsened the problem. That is why I described the Government's record as complacent: they have allowed this situation to continue for so long.
	Although the hon. Member for Walthamstow sought to define the difference between polyclinics and GP-led health centres, the latterat the very leastgive the appearance of being embryonic polyclinics. They have many of the hallmarks of a polyclinic and many people struggle to distinguish between the two. The Minister confirmed earlier that the Government are committed to introducing one GP-led health centre for every primary care trust, so what assessment have the Government made of whether that initiative will do anything to combat inequality of access? As the hon. Member for Banbury (Tony Baldry) said, if a polyclinic or GP-led health centre is placed in the centre of a city in a particular primary care trust area, it may do nothing to improve access for low-income communities that are some distance away. How well will that policy target resources at the actual problem?
	The Minister also referred to the other initiative to introduce 112 new GP practices in some of the poorest communities. The announcement was made a year ago, at the time of the interim Darzi report. What progress has been made? The Minister said that it was happening, but when is it happening? What is the time scale for introducing the new practices, and what is the mechanism for ensuring their arrival? Is it ultimately down to the discretion of the primary care trust? How will the Minister ensure that he delivers that commitment?
	I am pleased to hear about the start of the demise of the minimum practice income guarantee. As I have been saying for some time, that reform is welcome. However, the Minister said that it would be phased out, and reports of the agreement with the BMA also mentioned phasing out. What is the time scale for that? Can the Minister give a target date by which we will be rid of that mechanism for funding GPs, which he has agreed has nothing to do with quality or the extent of the challenge faced by GPs, and everything to do with historic payment mechanisms?
	Let me move on to QOFthe quality and outcomes frameworkwhich is the basis for incentivising GPs to engage in preventive health care and so on. In a booklet on inequalities of health care, the NHS Confederation specifically considered that subject. It described how the mechanism for rewarding GPs under QOF ends up giving more money to GPs in the wealthy areasthe leafy suburbsthan to those in the poorest areas.
	It seems bizarre that a system that is presumably designed to help reduce inequalities and to improve the health of the nation should end up paying doctors more where the problem is least. It does so for two reasons. First, it is easier to hit targets if a patient base is middle class and everybody is informed, educated and understands the importance of preventive health care. They will go along for their screenings and so on. In a community where people are harder to reach, it might be much tougher to hit the targets and to earn the income under the QOF system.
	The NHS Confederation also makes the point that the QOF formula remunerates practices with high disease prevalence at a lower rate than practices with a low disease prevalence. It states:
	The greater the prevalence of a disease, the less money the practice receives per patient.
	The confederation concludes that the structure of the QOF payment disadvantages practices in deprived communities. I have raised the subject before. What are the Minister and the Government doing to remove that ridiculous distortion, which provides a disincentive to doctors to work in the poorest communities? Surely it should be precisely the other way around.
	When will the Government consider ways of really incentivising GPs to work in the toughest, hardest to reach communities? It seems to me that the money should, as far as possible, be attached to the patient so as to encourage GP practices to take on more patients, and that there should be a premium attached for serving individuals from deprived communitiesa sort of patient premium to incentivise GPs to work in those communities.
	Next, I want to deal with the exclusion of osteoporosis from QOF. The subject has been mentioned by a couple of speakers. The independent expert panel made the case for osteoporosis to be included, and I disagree with the hon. Member for Walthamstow, who said that that was one more group arguing its particular interest. It is more than that. It is an independent panel that is designed to give dispassionate objective advice to the Government about what conditions should be addressed through the incentive scheme. The Government chose to ignore it.

Neil Gerrard: I want to make it clear to the hon. Gentleman that I am not in any way disparaging what the panel is saying. It sounded as though he was suggesting that I was doing that. My point was that, inevitably, when decisions are made about what is and what is not included, various interest groups will always believe that their interest has somehow been ignored. The panel is making a perfectly valid point.

Norman Lamb: I am grateful for that clarification; we are clearly in agreement.
	Let me quote the National Osteoporosis Society, which states:
	It is very concerning that this QOF review
	the one that has just taken place
	has not been subject to independent review and has been negotiated behind closed doors between NHS Employers and the GPC.
	Why is that important? Why should osteoporosis be included in the QOF process? The answer is that the process offers crucial preventive healthcare: there are 300,000 osteoporosis fractures every year, and independent evidence suggests that it should be possible to cut that total by about 50 per cent. through the early identification of a problem and treatment to strengthen bones.
	We have an extraordinary opportunity to reduce substantially the prevalence of osteoporosis fractures. The cost to the NHS and social care of treating fractures is some 2 billion a year, and fractures among people over 60 result in 2 million hospital bed days in England alone. Investing in preventive health care upfront could have a massive impact on the cost to the NHS, and it would also be critical in preventing the crisis undergone by patients who have to be admitted to hospital because of a fracture. When old people suffer a fracture, the result can be a permanent deterioration in health, as I am sure the hon. Member for Dartford (Dr. Stoate) can confirm.

Howard Stoate: indicated assent.

Norman Lamb: The hon. Gentleman nods in agreement. I therefore urge the Minister to look at ways of introducing osteoporosis into the QOF system, given the potentially massive benefits that could be achieved.
	I want to ask the Minister about progress on extending hours. I have always believed that there is a benefit to be achieved by extending hours within primary care, and my opposition to the Government's proposals had to do with the way that they sought to impose them. The announcement earlier this week suggested that virtually no progress has been made in some areas, with just 1 per cent. of practices in Liverpool going for extended hours. I should be grateful if the Minister said why he thinks there is such enormous variation.
	The pharmacy White Paper floats the idea that the current rules for GP practices with dispensaries should be changed. Such practices primarily serve rural areas but, taken together, the White Paper and the impact assessment appear to suggest that a GP practice could be forced to close its dispensary if there is a pharmacy within 1 km of it.
	I want the Minister to understand just how strongly people in rural areas feel about that. The current service is remarkably attractive, as it means that elderly people with a GP appointment in the early evening can walk out of the building with their medicines and take them straight away. It is an immensely valuable service, and losing it could force an elderly person to make a separate journey, perhaps of some distance. That seems utterly crazy to me, as the impact assessment suggests that the change could result in 700 dispensaries closing, affecting 2 million patients nationwide.
	Of great concern also is the possibility, which has been brought to my attention by local dispensing practices, that the change could undermine the viability of the range of medical services that such practices provide. Again, that would be to the detriment of people living in rural areas, and I urge the Minister to reject any change that would result in such closures. It would be a massively retrograde step.
	I want to say a word about practice-based commissioning. The Government lauded that as an initiative with enormous potential to develop services in the community. They said that it would provide convenience for patients because often they would not have to travel a long distance to an acute hospital. Lower-cost care closer to home was claimed to be the great potential benefit that could be achieved. Yet when we talk to GPs around the country, we discover that the scheme has largely stalled. It has suffered in part as a result of the reorganisation of primary care trusts. PCTs have been inward looking for the past two years, with people worrying about their own jobs. So many GPs tell me that when they try to engage with their local PCT to get something moving on practice-based commissioning, they get no practical interest or engagement from them. If practice-based commissioning is to achieve the potential that all of us see for it, something has to change to allow it to grow from the bottom up.
	The Conservative spokesman, the hon. Member for South Cambridgeshire (Mr. Lansley), referred to NHS dentistry. It is important to touch on that service. I shall confine my remarks to simply asking the Minister a question. When will there be a full and proper assessment of the impact of the new contract on access and on inequality of access? Great claims were made for the new contract and what it could achieve. The claims have not been met in reality. In many parts of the country, people on a low income and people who struggle to travel considerable distances have real difficulty in accessing an NHS dentist because there simply are not any available locally. There is an incredibly powerful case for revisiting the issue to make sure that the money available for dentistry within the NHS is deployed to the best possible effect and in particular to ensure access for those who do not have the luxury to be able to afford to go to a dentist privately.
	If the Government's intention for today's debate was to crow about their record on access to primary care, it has fallen rather flat because the record is not good. The Healthcare Commission today has identified access to primary care as one of the big challenges that we face. Confidence among GPs is at an all-time low. I commended a survey undertaken by Norfolk Liberal Democrats to the Conservative spokesman. I will send him a copy later. When we asked GPs in Norfolk their view of the Government's stewardship of the NHS, 0 per cent. said that they were positive.

Howard Stoate: rose

Andrew Lansley: One GP is positive.

Norman Lamb: Well, we will have to move him to Norfolk so that we can change the statistics.

Howard Stoate: Does the hon. Gentleman realise that if I were to move to Norfolk there would be an infinite percentage increase in the number of GPs satisfied? That would be something of a Government target hit.

Norman Lamb: I accept the point. It is much needed by the Government because at the moment the percentage could not get lower.
	Confidence in the Government's stewardship of the NHS, especially with regard to primary care, is at an all-time low. The record is not good. The Public Accounts Committee reported last week on the cost of the GP contract. The impact on productivity and the change in out-of-hours arrangements have also led to massive problems with access and anxiety among patients about how to access care. That has led, many reports conclude, to a mushrooming in visits to accident and emergency departments at enormous cost to the NHSagain, a counter-productive move.
	Access to good-quality primary care, avoiding admissions to expensive acute hospitals, must have high priority. It is time that the rhetoric was matched by measures that will have practical effect and really change things rather than the Government just claiming that they want to achieve change.

Howard Stoate: As the House is well aware, I am still a practising GP, so it gives me great pleasure to have caught your eye, Madam Deputy Speaker, in this important debate. I am sorry that more Members could not find time to be here.
	Every Member who has spoken so far has mentioned quality and outcomes and has commented on the variability of services, which is where I want to concentrate my remarks. There is quite wide variability of services, and I want to look at why that is, what we can do about it and what is at the heart of that thorny question.
	I do not want to rehearse all the figures and statistics released by the Healthcare Commission today. Members are aware of them and many of them have been mentioned already. However, one figure from a survey published by the commission in July 2008, based on interviews with 69,000 people in England, showed the variability that I am talking about. One of the things found by the survey was that the overall proportion of respondents who had waited two working days or more for their most recent appointment with a doctor had risen from 74 to 75 per cent. this year, which was a modest change. However, in the highest scoring trust, 89 per cent. of respondents said they were seen by a GP within two working days, yet in the lowest scoring trust only 43 per cent. of people had been seen within two days. That is a far more worrying statistic than any of the others I have heard this afternoon. Furthermore, 23 per cent. of patients who made an appointment felt that they should have been seen sooner.
	Those findings have been picked up by the Patients Association, which said:
	The Patients Association continues to monitor access to GP services and Out-of-Hours care very carefully. We regularly hear of patients experiencing difficulties in obtaining a GP appointment or a poor service when trying to access out-of-hours care. We call on both GPs and Primary Care Trusts to ensure they are providing the highest level of care possible to their patients.
	I am sure that plenty of colleagues in the House this afternoon will have been presented with examples from constituents of people waiting longer than they should to see a GP. The scenario where a patient rings their practice for an appointment and is told that nothing is available for the next three, four or five days, not just with their GP but with any GP, is one that I hear far too often for my liking.
	We can argue about the Healthcare Commission figures. Only yesterday, I had a meeting with Anna Walker at which we tried to pick to pieces why there was such a variation in the figures and why it looked as though only 31 per cent. of trusts were able to achieve the GP access target. The answer seems to hinge to a large extent on whether we say to a patient, Are you able to achieve an appointment in 48 hours? or Did you manage to actually get an appointment within 48 hours? That is when there is a much lower response. The figures need more examination, although that is probably beyond the scope of the debate.

Norman Lamb: I hear the possible explanation of the difference, but does the hon. Gentleman accept none the less that the greatest problem, whatever the measure, is in poorer, inner-city areas?

Howard Stoate: I entirely accept that point, which is important and worthy of closer examination, and I want to develop it in more detail.
	Many patientsoften vulnerable onestend to accept what they are told. If they are told, There's no appointment, come back tomorrow morning and you might be able to get one, they often do so. They are thus less likely to appear in the figures as missed 48-hour appointments. Other patients who may understand the system better and say, I know I'm entitled to an appointment within 48 hours are more likely to be given one. That explains to some extent why people in more disadvantaged areas are more likely to accept what they are told and less likely to demand their rights than those in areas with more vociferous and middle class patients.
	It is entirely possible for practices, perhaps unwittingly, to deflect patients for 48 hours, and such patients would not be picked up by the surveys. It would thus appear that they were performing better. I find it difficult to accept that situation. Why can many practicesit is probably even the majorityprovide a perfectly good service? They have no difficulty whatever in combining 48-hour access with appointments booked two weeks in advance. Why do so many patients and practices have no problems, whereas others seem to run into difficulty time and time again?
	We need to go back a long way and look at the origins of primary care in the health service in 1948, when, as Members know, independent contractor status was conferred on GPs. The system has served the UK remarkably well. It has managed to ensure that because GPs are independent contractorsin effect, private businesses working on a profit and loss accounttheir only payment mechanism is the bottom line of their practice profits. Those profits are the GPs' income, because there are no shareholders; the GPs share the profits as directors of the company. That has had an enormously beneficial effect on British general practice, and it explains why it is still one of the envies of the world. It is fantastically cost-effective. GPs are focused on what they do very well indeed and the system is extremely cheap, which is one of the things I want to consider. Our system, which is cheap, cost-effective and has served us well, has also allowed quite marked variations of practice and circumstances to build up. Let me suggest one explanation for that.
	Remarkably, over that time no Government have seriously challenged independent contractor status, and no Government have seriously looked behind it at exactly what it means. In fact, what it boils down to is that GP practices have been taken for granted. It has just been assumed that GPs are professionals, do a good job, look after their patients, do what they need to do and produce reasonably good outcomes. No one has ever looked beyond that.
	On the one hand, depending on which side of the fence one is sitting, one might say that that is a huge vote of confidence in the British general practice system, which has served us well. Others might say that it is mind-bogglingly complacent, because no one has ever looked very closely behind it. It is hardly surprising, therefore, that quite a variable quality has been built into the system.
	Under the old red book system, GPs were remunerated in a way that was purely beancounting. They were paid according to the number of patients and of services provided. One added them up on paper and sent the piece of paper off to what was then the family health services authority, and it sent back a cheque each month. That was that.
	The 1990 contract, introduced by the Conservative Government, extended that arrangement a bit by producing 27 outcome measures. GPs fulfilled those measures: they sent their pieces of paper off; they got paid. They were process measures, not output measures. They looked at how many patients had their blood pressure checked, how many had a new patient examination and how many had been given advice for obesity. Not once were GPs to produce any evidence that they had done any good by that method.
	All Members in the Chamber this afternoon have spoken about quality and outcome, yet the words quality and outcome effectively did not exist until 2004, with the new GP contract that this Government introduced. For the first time, GPs were measured on the quality and the outcome of what they were doing. The indicators in the QOF are all evidence-based. They are all carefully thought through by a panel of independent experts; agreed between the profession and the NHS Confederation as being the right indicators; and carefully monitored. The question is not how many patients' blood pressure has been measured, but what percentage of those patients have blood pressure within a certain rangewhat percentage of diabetics, for example, have cholesterol levels below 4, not how many people's cholesterol levels have been checked. The intention is to measure the number of patients whose measures have been improved, thereby leading to improved patient outcome on an evidence-based system. Ironically, although all hon. Members on both sides of the Chamber bang on about the need to improve the QOF, before 2004 it had never even been properly considered. This Government deserve a huge vote of confidence for doing that.
	I should like to take issue with my GP colleagues, but not only with them. There is variable quality, and some of it is down to GP practice; sometimes GP practices could, should and must do better. I intervened on the Minister to draw attention to the problem of 0844 numbers, which is an example of where GPs have not been very friendly to their patients. He needs to look at that. It is obvious to me that some GPs could and should do more, and I believe that with a bit of incentive they probably will be able to sort that out. The fact is, however, that we have allowed the variability to continue for too long.

Michael Penning: The hon. Gentleman is very generous in giving way. The undertaking that he is asking for from the Government, and particularly from the Minister, to abolish the use of 0844 numbers was given by the Under-Secretary of State for International Development, the hon. Member for Bury, South (Mr. Lewis), some time ago, when he was a Health Minister, and nothing has happened.

Howard Stoate: I accept that. I also accept the Minister's assurance that the matter is being looked into by the Government. I await, as does the hon. Gentleman, the outcome of the Government's deliberations, and I hope that this will be sorted out quickly. I think I have explained why there is so much variability, why practices have such different approaches, and why some provide services that are not up to the standard that we would like to see, whereas others motor ahead and produce everything that the Government want.
	The Minister mentioned the MPIG or minimum practice income guarantee. He is right to say that it was an historical device to ensure that when the new GP contract was brought in, no practice would suffer huge financial loss as a consequenceat least for the first three years, until its practice income had taken off and it had managed to produce income from elsewhere. However, I would counsel caution. We must not simply dump on GPs more and more of the work that they are currently unable to do, because it simply will not work if the Government expect GPs to work even harder to recoup income that will be removed from them when the MPIG goes.
	Let us consider the average working day for the average doctor. It is a sobering thought, and I want to share it because I think it is important. The average GP sees 35 to 40 patients a day. At 12 minutes or so per appointment, that is six or seven hours of consulting time. On top of that, they make home visits, of which there may be an unlimited number. They also have to undertake medical examinations for people requiring HGV or taxi-cab licences; write referrals to hospital consultants if a patient needs to be referred; and read and action all the letters that come in during the day to the practice from consultants who are treating their patients in hospital. They have to action pathology reports and electrocardiogram reports that come into the practice on a frequent basis, and they have a sea of repeat prescriptions to write for people who remain on medication. On top of that, the majority of GPs run clinics for child health surveillance, minor surgery, maternity care, diabetes, dermatology and joint injections. The majority of GPs are involved in teaching or training the next generation of GPs, and on top of that, they are expected to keep abreast of recent developments and ensure that they are up to date with the best possible medical practice and the latest Government missives. That is a pretty daunting work load. If we embrace the idea that a GP can simply do more because the incentives and QOFs have changed, the MPIG is going and there is a lot more work from extending their hours into the evenings and weekends, we have to be careful lest we kill the golden goose simply by putting more and more on to already hard-pressed practitioners.
	I should like to say a word or two about the Government's relationship with GPs. I have been critical, with good reason, of some aspects of GP performance, but the opprobrium that has been heaped on GPs in recent months by the media and other groups is undeserved and counter-productive. GPs are well rewarded under the terms of the new contract, and there are justifiable questions about how the profession has been allowed to dispense with out-of-hours services so lightly and with so little penalty. However, it was the Government who signed off on the deal, and much of the responsibility for the shortcomings in the contract must lie in their hands.
	Blaming the profession for having the temerity to make a good deal and then looking for ways to recoup the money that was spent on the contract is not a tenable long-term position for the Government to take. In a letter sent to me after a recent meeting, a group of GPs in my local area commented:
	You expressed the view that the Department of Health had a high regard for general practice, and saw GPs as a key component in the redesign and modernisation of the health service. The general feeling from my colleagues was that the Department of Health had a very strange way of demonstrating their regard for general practice, as demonstrated by their public pronouncements and attitude.
	That group of GPs is not a recalcitrant minority that is anti-reform and dismissive of the need to changequite the reverse, in fact. They are progressive practitioners who are doing their level best to work with the Government to improve access and delivery of services.

Norman Lamb: I completely agree with the analysis that the hon. Gentleman has offered. Does he think that that sort of thing has led to this extraordinary loss of confidence among general practitioners in the Government's stewardship of the NHS, which I am sure he accepts has taken place?

Howard Stoate: Well, that has been hyped as well, because personally, I do not see the complete loss of confidence that the hon. Gentleman mentioned with regard to his area of Norfolk. I obviously cannot comment on his local GPs, but my local GPs have not completely lost confidence, and neither have the GPs with whom I work closely up and down the country, those who write or phone me, or those with whom I work on many groups on medical matters. However, I accept that GPs' thoughts about the way in which things are going has taken a knock. I should like the Minister to clarify the Government's position and make the case that they are not anti-GP; they are not trying to bash the system, but simply trying to get better care for patients.
	I have given the House examples of cases in which GPs have felt undervalued and taken for granted. I do not think that the Government are going to win any friends among GPs unless we try to redress that important issue. During these difficult financial times, Ministers may believe that GPs will not win any friends by complaining about their pay and conditions. That is a fair point, but a damaged relationship between Government and GPs will have long-term consequences. We have seen examples of imported, privately contracted para-GPs who work 9-to-5 shifts with a half-hour break, providing GP services for patients in areas where there is a shortage of GPs. Their turnover rate is impressive and at one level they provide good value for money. They get a good throughput of patients, but whether patients are satisfied with that type of medicine and consultation is another matter. I do not believe that that is the way to proceed. Asking GPs to do more all the time without appropriate resources will not only alienate GPs; ultimately it will damage patient care and prevent GPs from being able to rely on the prevention and early detection of disease, which it is important that they do.
	I am in favour of the GP-led health centre model, as I have said on a number of occasions. A group of GPs in my local area has just been awarded a contract from a company to provide an out-of-hours centre and a GP-led health centre in Ebbsfleet, which is a fast growing area of my constituency. Those are the very GPs who are keen to progress, work with the Government and see the Government's model pursued.

Peter Bone: I am interested in the point that the hon. Gentleman makes. The centre that he describes seems similar to something in my area. Was that group of doctors engaged in that activity before the Government imposed their target for one such health centre in each PCT? Does it pre-date that target?

Howard Stoate: No. It was a response to the Government wanting to put a GP-led health centre into my area. The GPs have taken up the idea with a vengeance. They have seen that there is a gap in provision in the area. There is a new development around Ebbsfleet International station in my constituency, which will see many thousands of new houses and businesses moving into the area, and they recognise that there will be a need for new health facilities in the area. My local hospital has also looked forward to the expansion of its services as the population rises. That is entirely natural.
	What is important is that the GPs feel themselves to be supported, properly resourced and adequately advised by the primary care trust to make sure that the scheme is a success, because they want it to be a success. My point to the Minister is that if we are to make sure that GPs are willing to pick up the baton and run with it and produce extra services, we must send out a message that we are supporting them in the same way as we expect them to support their patients. I have heard from Members in all parts of the House that currently there is a real gap between the thinking of GPs who want to get on with the scheme and their perception of how the Government see them. That leaves something to be desired. I hope that my hon. Friend will look into that.
	The hon. Member for North Norfolk (Norman Lamb) mentioned the Dispensing Doctors Association and the view that we should be careful about how we handle dispensing practices. I am pleased that the consultation leaves four options open, and that the Government do not yet have a preferred view on how dispensing practice is dealt with. It is possible that when the consultation is finished, things will stay as they are. I emphasise that dispensing practices are a useful resource in some rural areas and provide a very good service to patients. I would like to make sure that that is not damaged.
	The other side of the coin is to ensure that pharmacy also has good access to patients. As has been mentioned in the debate, pharmacists can and already do provide a range of services that is expanding all the time and can be an important part of primary care delivery in the front line. I am pleased to see them expand those services. I am pleased, too, that the Government took seriously the report on the future of pharmacy from the all-party pharmacy group, which I chair. The report has received favourable comments from Ministers and I am pleased that they have examined closely some of our suggestions on how pharmacy might be progressed. That is a positive development.
	GP patient access is fundamental to how people see the health service. General practice is the front line of the health service. Ninety per cent. of all care takes place in a primary care setting. The majority of people see their GP or their GP practice three, four or five times every year. If we can ensure that we build on general practice, not only can we improve patient outcomes and patient well-being, but we can keep hospitals free of cases that are less serious and ensure that they can get on with the heavy duty and high-tech cases that only they are equipped to deal with. If we get that right, we will have a health service that we can be proud of and continue to be proud of into the future. I am sure that that is what everyone in the House wants and what Ministers want.

Richard Taylor: It is a delight to follow the hon. Member for Walthamstow (Mr. Gerrard). Having trained in London rather a long time ago, I know what the standard of general practice was then, and I am very pleased to hear that it is so much better.
	I am delighted to follow the hon. Member for Dartford (Dr. Stoate), because he has removed the need for some of what I had intended to say. I had intended to stand up for GPs, because their morale is incredibly low. Indeed, after I talked to my GP he sent me a few thoughts:
	Why are we under attack when we are efficient, good value for money and valued by our patients?
	His practice spends precisely 2 per cent. on management, because the doctors do most of the management. This is his perception:
	Government has no idea of what we do and what we achieve. The fiasco of out of hours shows this. As did our over performance in QOF. Which should be a thing of celebration not criticism.
	Consultations are now highly complex. Minor illness is dealt with by nurse practitioners. We are dealing with complex cases inadequately supported by the acute trust.
	My GP's description supports what the hon. Gentleman said about timings in the day almost to the minute. GPs start work at about 7:30 am and finish at 6:30 pm. Six hours and 40 minutes are taken up in consultations, with 34 patients seen, but GPs are also engaged in making telephone calls, writing referrals, looking at reports, making home visits and so on. They therefore fully justify their pay. I hope that the Minister will acknowledge that to make GPs feel a little less disregarded and insufficiently appreciated.
	I know that our time is limited, so I will focus the rest of my speech on out-of-hours care, which is crucial. Access to out-of-hours care, which is not the function of A and E departments, is what has really brought the Healthcare Commission ratings on emergency care down. Years ago, GPs provided out-of-hours care, which meant that they were working night and day, which was not very good. As a patient, one felt guilty about ringing up a GP in the middle of the night, knowing that they had been working all day. Then we had the local co-operatives, which were excellent. They were a conglomeration of the local GPs working together in a rota to cover the nights, so that they did not have to work in the day as well.
	Unfortunately, we lost the co-operatives when the contract was introduced. It was amazing that GPs were no longer expected to work at weekends, which meant that PCTs had to provide out-of-hours care. However, in my area and many others that has not been a success. I am pleased to say that the PCT in my area realised that it had to reform the service, which was put out to competitive tender. Rather to my surprise, a conglomerate of GPs from Suffolk has taken over the provision of out-of-hours care in the whole of Worcestershire.
	I am so far very pleased with the intentions of that firm, although I am going to follow its progress closely. There is a bit of a flaw in the contract, which was short sighted but understandable, in that the firm covers only the patients of GPs registered in Worcestershire. Unfortunately, the rest of my hospital covers the area right on the Shropshire border, so when patients from Shropshire, from as little as three or four miles away, turn up in the middle of the night with something rather nasty, the firm says that it cannot take them, because the contract is not with the Shropshire GPs. I am looking into the matter, because it is in the firm's interests to take more people, because it will get the money for doing so. That was a difficulty with the contract when it was first written, but I am optimistic that it will be improved.
	The one thing that would most helpfully improve out-of-hours care has been mentioned, which is a single telephone number. If people are really desperate, 999 is fine, but we want another number. As I have said before in similar debates, people do not know whether to contact out-of-hours care or go the minor injuries unit, the A and E department or the walk-in centre. They do not know who to ring, so we want one number. In previous debates with the Minister, he has said that he is looking into the supply of a single number.
	An organisation called NHS Pathways operates a brilliant triage system that has been trialled in various parts of the country, and those trials have been successful. I have here the minutes of the AGM of the North East Ambulance Service NHS Trust, where NHS Pathways was trialled:
	The year also saw confirmation that the clinically-based assessment systemNHS Pathwayswas a safe and efficient method of call handling...The clinical evidence-base underpinning it means NEAS is in a position to assess calls from a much wider range of patients, not only those who have chosen to access the '999' number, and to use alternative pathways of care that can be referred to from the system that is most appropriate for the patient's needs.
	The trust has already noted areas of significant improvement, including a considerable reduction in the number of patients going to A and E departments unnecessarily.
	NHS Pathways is a marvellous triage system, and if itor something similarcould be accessed from a single phone number, it would be a huge help, particularly for out-of-hours care. I should very much like to find out from the Minister whether he will push NHS Pathways as a useful form of access, and whether we can aim to have a single number.

Peter Bone: It is a pleasure to follow the hon. Member for Wyre Forest (Dr. Taylor), who, as usual, has made some powerful and important points about the health service. I start by thanking GPs across the country for what they do. I know that we are discussing access to primary care, and that we have totally ignored dentists, whom I would like to mention briefly. GPs are valued by my constituents, and not least by me and my wife, as one of them effectively saved my wife's life. It was an advantage in that situation that the GP knew her, because she had been a patient for a number of years. Many of the GPs in my area are concerned that, if we were to introduce GP-led health centres, that continuity might not continue.
	Age Concern is also worried about that. That matter has not really been touched on in the debate so far. Age Concern states:
	Many older people value the continuing relationship they have with their GPthat must be retained in any reform of the system. We would therefore want a commitment that the personal GP patient relationship would be protected.
	That is extremely important. Another point that Age Concern makes is rather the reverse of the Minister's wish to make more time available to patients in the evenings and at weekends, so that people who go out to work can have access. Age Concern makes the very fair point that it wants to ensure the same amount of weekday availability for the people whom it represents, because that is when older people want to go to see their doctor.
	The hon. Members for Dartford (Dr. Stoate) and for Wyre Forest are both GPs, and they have made the point that GPs work exceptionally hard. If we ask GPs to work in the evenings, they will take time off in the daytime to compensate for thatit has to be that way. A local GP from Finedon in my constituency came to see me and told me that the new system was absolutely nuts. He has a surgery during the day and anyone can come along. He sees patients during the day, but now he has to open his surgery one night a week and sit there with his practice manager while nobody comes to see him. It is a pointless exercise.
	If I have learned one thing from this debate, it is that there is a huge difference around the country and that one idea or size does not fit all. When I grew up, if I needed to see a doctor, I saw one whom I knew. We could ring up, make an appointment and we would get seen. If I needed to go to the dentist, I would make an NHS dentist appointment, and I would be seen. If I needed to go to hospital, it would be arranged through my local doctor. If I was ill in the evening, the local doctor would come out. I remember that I once needed to see a doctor on Christmas day, and the senior partner in the practice came out to see me. All that was under what many Labour Members like to portray as the wicked old days of the Tories, but it seemed to me to work well. What we should do is build on a system like that rather than apply top-down approaches. I understand that the Minister has adopted those approaches for the very best motives, but I just do not believe that they will work. Why not let existing GP practices expand and develop services that are relevant to their areas?

Howard Stoate: As I have said, the answer to the question is that there is great variation. The good practices will no doubt pick up the baton and provide everything that the Government could possibly dream of. However, the hon. Member for North Norfolk (Norman Lamb) has pointed out on the basis of surveys in his area that there are far too few practicessometimes as few as 1 per cent.able or willing to do that. We must try to reduce the variation.

Peter Bone: I am grateful for that intervention, which adds to my point that there are big differences around the country. My argument is that imposing one GP-led health centre in every PCT is not right.
	This morning, three hon. Members who are currently in their places were sitting in the Health Committee. We heard that the Government have found 250 million of taxpayers' money to inject into primary care. However, 150 million is going into a minimum of one health care centre per PCT, and we do not know how the other 100 million will be divided up. I was trying to understand the best way of allocating that money so that it was focused on the areas that needed it most, and I suggested a very simple system.
	The Government devote a lot of time, concern and expense to working outon the basis of deprivation, growth and other factorswhat each and every PCT needs as a minimum, but they do not fund every PCT to that level. Because some areas are overfunded, others are underfunded. My Northamptonshire PCT happens to be the worst funded in the country, so I declare a certain interest in finding a solution. Surely it would be better to take this 250 million and give it to the PCTs that are underfunded according to the Government's own criteria, and then let them develop local solutions to their problems.
	I have another idea for raising some extra money to put into the pot. Why not get rid of the strategic health authorities? I cannot see that they do anything other than push pieces of paper about and tick boxes. The only criterion that an SHA takes into account as making for a good PCT is ticking all the boxes; it does not take local need or local decision making into account. What we should do is get rid of all those pen pushers, take this money and put it into primary access.

Richard Taylor: Towards the end of this morning's Health Committee meeting, we were all convinced of the value of SHAs, because they carried out the consultation for Lord Darzi's review and canvassed the views of patients, citizens and staff. I changed my mind about the SHAs at the end of that meeting.

Peter Bone: I certainly did not. My opinion was the same at the end of the meeting as it had been at the beginning. The witnesses confirmed all my thoughts about bureaucrats wasting time and money.
	Talking of surveys, I run a tracking survey in my constituency. It is called the listening survey. One of the questions is What concerns you most? Health is always one of the two top issues. There are so many other issuescouncil tax, pensions, education, immigration, which is a huge issue in my area, and overdevelopmentbut health is always first or second.

Michael Penning: Does my hon. Friend think that if he asked his constituents whom they respected most, GPs would be quite high on the listhigher than Ministers or Members of Parliament in general?

Peter Bone: I should hate to include that question in my survey. If I asked Do you value your GP or me?, it would be like the election return in an African republic: 100 per cent. would value the GP and none would value me. So, with all respect to my hon. Friend, I do not think that I shall include that question.
	The question Why do people put health first or second? leads to another question. A number of Members have said that many people make their local hospital their first call, because they can obtain primary care in the accident and emergency department, and they are not sure where they should go or cannot see their GP. I only wish that we had that option in my area. We do not have a hospital, although an area of that size should obviously have one, and if my PCT were funded correctly, it would have one.
	As for access to GPs, Wellingborough has one of the worst GP-patient ratios in the country. Because the town is expanding, people coming into it cannot get on to GPs' lists. They have to be forced on to them through the PCT. Again, the position varies considerably around the country. I feel that rather than there being all these plans and targets, money should be found to provide more GPs. We are lagging behind the rest of Europe when it comes to GP numbers. We are asking GPs to do moreto work longer hours, or to work at weekends and take time off during the week to compensatewhich is not at all helpful.
	On average, a GP sees 34 patients a day. Goodness me! I shall sit down at 9.30 tomorrow morning, and after I have seen 12 of my constituents, I shall be completely worn out. The fact that our GPs see 34 people who are really ill in a single day is an extraordinary testament to them.
	Out-of-hours access is never an issue in my constituency. The doctorsor the doctors and the PCThave worked it out. Many surgeries stay open in the evenings, but, as was mentioned earlier, there are doctors' co-operatives running night-time services. I have a seven-year-old. He was ill one nightnot ill enough for us to dial 999 and take him to a hospital, but ill enough for us to ring NHS Direct, which told us that we should use the out-of-hours service. When we went to the out-of-hours service, we were seen very quickly and it was a first-class service. In my area, there is no demand for polyclinics or GP-led health centres, but the Northamptonshire PCT had planned to put three in the county. Sense has prevailed and that has been knocked back to one, which no one seems to want.
	The hon. Member for Dartford made a strong case about how GPs in his area were embracing the scheme and bringing it forward. That is the way in which it should happen. If people want to do it, they should do it. In my constituency, there was a doctor's surgery that was already planning to move to a bigger location and to add services. That is the sort of thing that is evolving and should be encouraged, but local doctors are concerned about funding.
	The Minister will probably pull me up on this, as I will not use the right terminology, but, as I understand it, if there is a polyclinic or a GP-led health centre in the town, it will attract people because of the out-of-hours service and the seven-days-a-week service. People will register with that centre, which is how it will be funded in due course, and move away from existing surgeries. It is rather like cherry-picking. The people who tend to be healthier will go to the GP-led health centre and my surgeries will be left with the more difficult casesnamely, the elderly and the young. Those surgeries have to spend more time on them, but because it is a per capita funded system, their income will go down. Therefore, they will spend longer with the patient for less money and not be able to develop their services. That cannot be what the Government planned. If I have that totally wrong, I would like the Minister to tell me in his winding-up speech. That issue really concerns local doctors in the area.
	I want to move away from GPs, because, in many respects, the problem is not as serious in my area as it is elsewhere. What is fundamentally wrong and driving people up the wall is NHS dentistry, or should I say non-NHS dentistry? Like thousands and thousands of people in Northamptonshire, I have had to take out private insurance to continue to see my dentist. When I talk to my dentist, he makes a powerful case. Admittedly, he is standing over me with a drill at the time, but he makes the case strongly that the Government have forced him to do what he has done. Here am I and thousands and thousands of others paying through taxes for an NHS dentist, yet there are no NHS dentists in the area and I am paying 48 a month extra for insurance. That cannot be right. That cannot be how NHS dentistry should work.
	The Minister said nothing about dentistry in his opening remarks. I am sure that that was not an oversight. I think that he wanted to avoid a hugely embarrassing situation. The one thing that I can say with certainty is that NHS dentistry is worse now under this Labour Government than it was under Margaret Thatcher.
	Many things may have improved in the health serviceif funding for the health service is increased in real terms by 82 per cent., things should improve. The fact that most of that money has been wasted and that we have seen only a 23 per cent. increase in outcomes is down to the Government's inefficiency. The fact that the median waiting time is still longer under Labour than it was under the Conservatives is a minor point when we are talking about access, but the Minister has to answer this question: why is it that my constituents and others in Northamptonshire cannot see an NHS dentist? If one rings up and says, I must see an NHS dentist, the reply is, If you do not mind going out of the county, you can see one. That is the reality of NHS access in my county.

Michael Penning: It is a pleasure both to wind up on behalf of Her Majesty's Opposition in this important debate, and to follow three members of the Health Committee. Having left the Committee myself only just over a year ago, I know how diligently they work. The Health Committee is one of the great Committees in this House, and I do not hold back in my praise of italthough I wonder whether the Minister might drag himself away from his notes for five seconds and listen to a contribution this afternoon?  [Interruption.] I may tease him a bit more, as I have now got his attention.
	Interestingly, the Minister was, I think, referring to spin when he complained about the coverage of the Healthcare Commission report in this morning's press. That is astonishing coming from a member of a Government who have welcomed back into their ranks Lord Mandelson, a man who got his reputation from practising the black arts of spin in the 1990s.
	Perhaps I can tease the Minister a little more? On page 68 of that report, reference is made to an access to a GP indicator. The report is not as definitive as it might have been because some areas refused to return any data. One such area was Devon, which is run by the Minister's own primary care trust. It is a shocking indictment of the Minister that he cannot even control his own PCT by getting it to give data back to the commission, let alone understand what is going on. The Healthcare Commission report is timelyalthough I am sure the Government were not expecting it to be published at this time when they timetabled this debate for this afternoon.
	I will try not to go over the points raised by the shadow Secretary of State, my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), but instead I shall cover some areas I have a personal interest in and some responsibility for. I will come on to urgent care and dentistry, which my hon. Friend the Member for Wellingborough (Mr. Bone) referred to, and polyclinics.
	However, I must first highlight something. If Ministers come before the House and make commitments to Members and to the country that they will address certain matters, the public have the right to expect that to happen. Therefore, given that the former Health Minister, the Under-Secretary of State for International Development, the hon. Member for Bury, South (Mr. Lewis), came to this House and promised he would address the 0844 number issuewhich is leading to our constituents being ripped off when they phone their GP surgeriesand that that practice would stop, it is astonishing and unbelievable that, in this later debate, Labour and Opposition Members have highlighted the problem of patients still paying these charges.
	We must also address the fact that the Government have gone to war with the GPs. I do not understand why, as the Government brought in the new contract in 2004. It was not written by the GPs or the Opposition; it was a Government contract for better health care in GPs' surgeries. The GPs took it and delivered it to their patients, but then the Government started to attack GPs throughout the country. The hon. Member for Dartford (Dr. Stoate) was absolutely right: morale is not great. For the first time since I have been involved in politics, all the GPs in my constituency have come together with the community to complain about what is going on in health care.
	We should briefly address the polyclinics issuealthough I know the Government do not like to call them that. The Prime Minister stood at the Dispatch Box and said there will be 150 polyclinics in London. The Darzi report said that, and the Prime Minister said it would be imposed in London. Rightly, London is revolting against that, and areas of London say they are not going to have them. In some areas in London and the country a polyclinic might be a good thing. I listened to the comments of the hon. Member for Dartford; if he has an expanded area and there is no existing provision in it, a polyclinic might well be a good way forward in that part of his constituency. However, it is clear from other Members' comments that in the other parts of the country where they are being imposed, it is not right that they will be plonked down in the middle of an area regardless of whether there is a need.
	I am sure the Minister is aware that I will raise the issue of the polyclinic that is being imposed in the middle of Hemel Hempstead town centre. Every GP surgery has signed an open letter to the PCT, along with myself and the patient groups in the town, saying, Please do not impose this on us.
	Not one GP surgery in that part of my constituency has a full list. The other evening, I purposely made a 7.30 pm appointment with my GP at one of those surgeries, just to see what demand there was. I could have gone at another time of day, but I booked online and went at 7.30 pm. How lonely I was. I got there five minutes early and was seen five minutes early, because there had been no patients in for the previous half an hour. There was no one booked in after me either. There were two receptionists on dutyquite rightly, because they should not be left alone in that situation at that time of night. The pharmacy attached to the surgery was open, and my GP was there. I saw my GP, and we then left and had a conversation about a lot of other things. The demand is not there. If it were, the surgery would be open at that time day in, day out. The polyclinic is to be only 200 yd to 300 yd away from there.
	There are parts of Hertfordshire, in the same PCT area, that might well need such a clinic in future. Some 80,000 homes are being imposed on Hertfordshire, not least 18,000 in my constituency. If those homes are to be built, a polyclinic might well be the right vehicle for delivering primary care to my constituents, but to say that one size fits all around the country is wrong.
	I was interested to hear the hon. Member for Dartford, who brings his expertise to the subject, say that GPs have got together to run clinics, but in most parts of the country they are being prevented from doing so. Two of the GP surgeries in my constituency would probably like to join together to run a clinic rather than compete, but they are being prevented from doing so.
	I shall touch on a couple of points that hon. Members have made before turning finally to dentistry. The hon. Member for Walthamstow (Mr. Gerrard)I know that part of the world well, having grown up thererightly said that there are good GP surgeries and bad, and that some offer more services than others. I am sure that he is aware that because of how the funding formula works within PCTs, some GP surgeries get double the money that others get.
	I was interested by the Minister's saying that one reason for the problems in delivering primary care was the reconfiguration that had taken place around the country. There may be an argument for that, although I have not heard that one before, but in London there was no reconfiguration. The PCTs were left in situ as they were before, so that argument does not stack up.
	I agreed enormously with the hon. Member for North Norfolk (Norman Lamb), the Liberal Democrat spokesman, when he talked about his own surveys. We are all doing that type of surveyI am sure that it is not just a Liberal Democrat thing. We all try to make contact with our constituents and find out their concerns. GPs are not happy, and they feel as though they are being persecuted even though they are delivering front-line services to our constituents in a most professional way. Where there are problems, they are for the PCTs to address in their commissioning. That is their role in life.
	I was slightly concerned when the hon. Gentleman talked about the Liberal Democrats' policy that if patients are not treated in a timely fashion, they should be able to go off to the private sector. I would like to see the costings for that, if the Liberal Democrats would like to publish them. It sounds as though they must be quite phenomenal.

Norman Lamb: I mentioned earlier that that policy was based on the Danish system. The evidence from Denmark is that it has massively increased efficiency in the state sector, thereby saving money.

Michael Penning: We examined the methods in other countries in the Health Committee, but a completely different type of health care is provided in Denmark, Sweden and other countries.
	As always, it was a pleasure to listen to my friend the hon. Member for Wyre Forest (Dr. Taylor). He is renowned in the House, and particularly in the Health Committee, for his expertise. It is very important that we all understand the type of care that our constituents want. They do not want to go and meet a stranger, or see a different GP every time they need some care. They want the relationship provided by years of work together, often down the family line. Although GPs in Worcestershire were pressed, it is a crying shame that GPs from other parts of the country are coming down to Worcestershire, because Worcestershire GPs probably understand the hon. Gentleman's constituents much better and would represent the way forward.
	We are pressed for time, but I want to make a couple more comments. The hon. Member for Wyre Forest alluded to the fact that we must address the out-of-hours urgent care system. So many people are frightened and need help, and they do not know the myriad numbers involved. I know that NHS Direct has tried desperately to get its number into the public's perception, but people still do not know it. The branded number that people know, 999, is sadly being abused on a daily basis. We must get another number branded quickly, before these numbers disappearthe European Union is progressing with these 116 numbers as we speak. He also mentioned the important NHS pathways software, and I have seen it working brilliantly in the north-east.
	My final point is about dentistry, which is the part of primary care missing from the Minister's speech. It is crucial that this Government address the mess that they have created by imposing the dentists' contract on this country. So many people cannot see an NHS dentist, but they deserve to do so, because that is what they pay their taxes for, and so it is about time that this Government scrapped their ludicrous contract.

Ben Bradshaw: I shall endeavour to respond to as many of the points made in this good and constructive debate as I can in the short time that has been left to me. I hope that hon. Members will understand if I am not able to respond to their points, and I shall endeavour to write to them where that is the case. [Interruption.] The hon. Member for Hemel Hempstead (Mike Penning) said from a sedentary position that I should not have spoken for so long earlier, but he may recall that I was extremely generous in taking interventions. That was why my introductory comments took so long. I should warn him that, as a result, I do not intend to take any interventions in my summing up.
	My hon. Friend the Member for Walthamstow (Mr. Gerrard) made an interesting speech about the transformation of the health service that he has witnessed in his area over the past few years. He made a specific point about osteoporosis and the quality and outcomes frameworkQOF. It might help if I were to inform him that general practitioners are rewarded for improving particular clinical services, including those in connection with osteoporosis, by not only the QOF, but the enhanced services. This year, the enhanced services have already been rewarding GPs for the work that they done on osteoporosis. The rewarding has been to the tune of 50 million on five clinical directly enhanced services including osteoporosis. Thus, some of the progress that he would like to see has already been made. He also asked when the National Institute for Health and Clinical Excellence consultation on the changes to the QOF process would be published, and I am advised that we intend to publish that by the end of October.
	The hon. Member for Banbury (Tony Baldry), who is no longer in his place, asked why there was a reason to have a health centre in his areawe dealt with that in some detail at the timeand why Oxfordshire's primary care trust did not seek to have more centres. It is perfectly within its rights to seek to have more centres.
	In contradiction to what was said by the hon. Member for Wellingborough (Mr. Bone), I am informed that Northamptonshire's authority still intends to procure four new GP-led health centresone before Christmas, another before March next year and two more thereafter. We have stressed all along that primary care trusts are perfectly free to decide the pattern of health care provision in their areas.
	My hon. Friend the Member for Stroud (Mr. Drew) highlighted the fact that Gloucestershire PCT was one of a small number of PCTs that, according to the latest figures, had not yet progressed very well, if at all, on extended hours. I am happy to be able to inform him, again via  Hansard, because he is no longer in his place, that Gloucestershire has rapidly caught up, that 34 out of its 84 practices have extended opening hours and that the PCT is confident that it will achieve the 50 per cent. target next monthtwo months ahead of schedule.
	My hon. Friend the Member for Dartford (Dr. Stoate) and the hon. Member for Wyre Forest (Dr. Taylor) both did a sterling job of standing up for GPs. In every speech that the Secretary of State and I make, we emphasise the incredibly valuable work that GPs do and the contribution that they make. I have defended today, as I do regularly, the contract that we brought in. I said in my opening remarks that it was vital that GPs were rewarded properly, because they had not been in the past, which was why we had such a problem with recruitment and retention. That is not to say that we will not have disagreements and, earlier this year, we had such a disagreement about the introduction of GP-led health centres with the BMA leadership. My hon. Friend was on our side of that disagreement and, as he rightly said, had discussions with his local GPs who are now involved in the delivery of one of those health centres in his area. We will praise primary care and the work of GPs when that praise is due. The vast majority of GPs do a fantastic job, but it is also the role of Government to try to improve things and to get better value for money out of the contract on behalf of the taxpayer.
	In response to the questions that the hon. Member for Wyre Forest posed about urgent and out-of-hours care, I welcomeas he doesthe changes in his area. Just because the service is being provided by a Suffolk co-operative does not mean that it will necessarily be substandard. The hon. Member for South Cambridgeshire praised Devon Doctors, a doctors' co-operative from my area that happily and successfully runs the out-of-hours service in Devon and has expanded its tentacles all over the place. I hope that the new service will be an improvement on the last one in the constituency of the hon. Member for Wyre Forest. As I am sure he will have noticed, we said in the next stage review that we will
	consider options to improve and simplify access for the public to urgent healthcare by exploring the introduction of a single three-digit number in addition to the emergency services number 999.
	We expect to publish further details on that work later in the autumn.
	The hon. Member for North Norfolk (Norman Lamb) asked why there was such a variation in the performance on extended hours so far. We are not sure, but there may be several reasons for that. Some PCTs may have been a bit slow off the mark. In some areas where local medical committees are more powerful, they may be holding out for a better deal. It may be some time before they hit the target. In the case of Liverpool, the low offering is due to practices not meeting the core DES criteria. The PCT in Liverpool is working hard to achieve compliance and some practices were working for DES before signing up. The PCT says that it is confident of achieving at least 50 per cent. by the end of the year, which is what the Government expect of it.
	The hon. Gentleman also asked me about comments in  Pulse. I apologise if I am not such an avid reader of the GP press as Opposition spokesmen, but I am informed that the quotation to which he referred was a misquotation. The official concerned actually said that PCTs have a choice in contracting with their practices through a local contract or by using the national direct enhanced service. However, PCTs must ensure that local contracts meet core minimum standards. They can then build on those to expand and enhance the services.
	The hon. Gentleman asked what role QOF was playing in reducing health inequalities. Research by the national primary care research centre in Manchester shows that the performance of practices in deprived and disadvantaged areas has significantly improved since the introduction of QOF, and that practices in those areas achieve as well as other practices. I agree with the hon. Gentleman that more can be done, which is exactly why the agreement this year will end the prevalence adjustment that disadvantages practices with the highest number of patients with certain diseases. That adjustment will end completely in 2010, when practices will be rewarded on true prevalence, not adjusted prevalence.
	The hon. Gentleman also asked how long it would take to phase out the minimum practice income guarantee. That depends on what level of uplift the Doctors and Dentists Review Body, the independent pay review body, recommends for primary care. For argument's sake, if it recommended a 2 per cent. uplift this year, and that was repeated in subsequent years, it would take five years to phase out the MPIG completely, apart from a small rump of practices that would need some level of protection. I am also informed that if there were a 2 per cent. uplift this year, it should reduce the amount of protection moneys paid by about 50 per cent. nationally in the first year, so that would be a big step forward. We will continue to work with the BMA to secure year-on-year progress.
	The hon. Gentleman also asked what role GP-led health centres will play in helping to address health inequalities. They will play a role through the additional and enhanced services that many of them will offer and the community-based services with which they will be co-located. His own, in Norwich, will be providing sexual health services, and I am sure that that is something that he will welcome.
	In response to a point made by the hon. Member for Hemel Hempstead, the latest information is that about 40 per cent. of all those invited to tender for the new health centres are GPs themselves.
	 It being Six o'clock, the motion lapsed without Question put.

HEALTH CARE (BEXLEY)

Motion made, and Question proposed, That this House do now adjourn. [Chris Mole.]

David Evennett: Bexley borough is a great place in which to live and to work. It has many good and positive attributes, including its location, the many open spaces and places of interest, excellent schools and facilities and a good Conservative council led by Councillor Teresa O'Neill. However, there are a number of local concerns, and among the major concerns is the issue of health care in the borough. I am therefore grateful for the opportunity to raise some of the concerns about health care in Bexley in the debate.
	I am delighted that my hon. Friend the Member for Bromley and Chislehurst (Robert Neill)my long-term personal friend as well as my neighbour and colleagueis in his place this evening. I am also grateful that the hon. Member for Erith and Thamesmead (John Austin), a fellow MP for Bexley borough, is with us for this important debate. Thirdly, I am delighted that my hon. Friend the Member for Hornchurch (James Brokenshire), who is the Conservative parliamentary candidate for the constituency of Old Bexley and Sidcup, is here to listen to the debate, too.
	My hon. Friend the Member for Hornchurch has already been very active in our area on this and other issues. His positive contributions to the debate locally have been welcome, in marked contrast to those of some of the Labour parliamentary candidates, who still seem to be rather wedded to spin and inaccuracy and do not seem to take on board the concerns and views of the people of the boroughparticularly the views of constituents in Bexleyheath and Crayford and in Old Bexley and Sidcup.
	The Minister is a fair and reasonable man, and I hope that he will take on board the concerns felt across my borough. We do not feel that the Government are taking seriously residents' views, wants and needs about health care at this time.
	We accept that there has been increased taxation and increased spending on health. There has been some considerable local improvement, as we know, across London. The Government are to be commended for what has been achieved. However, Bexley residents are concerned that there is a regrettable planned programme of downgrades and cuts to our local NHS. I hope that the Minister will listen to our heartfelt pleas and will take on board the concerns, and I hope that he will go back to the Department and act accordingly.
	It is, of course, particularly opportune that we are holding this debate on a day when the Healthcare Commission report is published showing that in London service quality has declined. Is it any wonder that Bexley residents are concerned about their health care?
	I turn, first, to Queen Mary's hospital, Sidcup, in the south of our borough and the proposals made under A Picture of Health. Over the past year, residents from Bexley and the surrounding boroughs have been campaigning vigorously against the closure of the accident and emergency, maternity and children's departments at Queen Mary's hospital, Sidcup. The campaign has been ably led by Bexley councillors Sharon Massey and David Hurt. Those of us who live in the area and represent the local community believe that those services are vital to local people. There has been considerable concern about the hospital's future should the proposed changes go ahead. There is a real fear that if the changes are implemented, the long-term prognosis for Queen Mary's Sidcup will be decline.

John Austin: The hon. Gentleman has referred to accident and emergency departments, but he will know that the plans under A Picture of Health provide for a 24-hour urgent care centre to cover all but the major emergency, blue-light casualty services. In the unfortunate event that he were to suffer a stroke or have a cardiac arrest, would he rather go to the hospital that is nearest, or to the one with the full diagnostic facilities that might save his life?

David Evennett: The hon. Gentleman will have to wait and listen to the rest of my speech, but the most important point is that Queen Mary's hospital has a fully active accident and emergency department. Of course we accept that people would want to get the best treatment that the major hospitals specialising in treatment for heart and stroke problems offer, but we are talking about something in between, and the present services are greater than what would be provided if the proposals go ahead. That is the crucial point and, although I have a lot of respect for him, the hon. Gentleman is trying to be rather too clever by half on this matter.
	The board of A Picture of Health was set up to review services in south-east London. It has decided that the Queen Elizabeth hospital in Woolwich, the Princess Royal hospital in Farnborough and Lewisham hospital should retain their accident and emergency services, while Queen Mary's hospital should lose them. Many residents are concerned that closure of those services at Queen Mary's would mean that some patients would have to travel much further to obtain treatment.
	Transport is a very important issue in our area. Accessibility for treatment, consultation and visitors is all important, and we all know that transport links in south-east London are not good. It is unacceptable to say that the alternatives are only 5 or 7 miles away, as the impact would be felt more by those in our community who are already disadvantagedthe elderly, mothers with young children and people without cars. Those are the key issues.

Bob Neill: I congratulate my hon. Friend on securing this debate on a very important issue. May I add my support to his observations on behalf of those residents in that part of my constituency of Bromley that adjoins his area, as they also use the services at Queen Mary's hospital? He may be aware that I carried out a survey of 9,000 of my constituents who are affected and there was not a single response in support of the proposals, not least because not one of the four options included keeping A and E on the Queen Mary's site. That stokes up real concerns that the part of the site not covered by private finance arrangements may eventually be disposed of.

David Evennett: My hon. Friend makes a very telling point, and his findings are replicated in my borough.
	In March this year, more than 1,500 people attended a march against the proposals that was organised by local Conservatives. I presented a representative of the A Picture of Health board with a petition containing more than 8,500 signatures, including those of children, parents, doctors, nurses and other professionals from the health service. I believe that that demonstrates the strength of feeling among local people about the A Picture of Health plans, and their desire to retain vital services at Queen Mary's hospital. As my hon. Friend the Member for Bromley and Chislehurst said, residents of Greenwich and Bromley joined Greenwich residents in the rally.
	We were supported by the Mayor of London, Boris Johnson, who has offered his support throughout the campaign. In his letter to us, he stated:
	It would be devastating for local people, if Queen Mary's Hospital in Sidcup is downgraded to a borough hospital, and it loses its emergency services, including AE, children's and maternity department, under A Picture of Health proposals...I am deeply disappointed by these proposals and will do everything I can to help the residents of Bexley in their battle to keep the important services provided by Queen Mary's. I have already stated that I will give evidence if the Government refers the case to the independent reconfiguration panel.
	That is tremendous support from our Mayor of London. I also have an email from the Bexley local medical committee, an elected body representing GPs. It states:
	The consultation was confusing with A Picture of Health and Healthcare for London running concurrently. In our opinion the views of the public were not taken into consideration and the outcome seemed predetermined.
	That shows that professionals, politicians and all sorts of people in the community are very concerned about the proposals.

James Brokenshire: My hon. Friend is making some powerful points. I was at Queen Mary's hospital yesterday and I was impressed by the professionalism of the staff and the real care, focus and attention that was given to patients. There were some very high standards.
	My hon. Friend has mentioned his concern about pre-determination and the fact that the views of local residents were not properly taken into account. Does he share my concern and that of other residents that the decisions appear to have been made on the grounds of finance and the existence of PFI hospitals in the vicinity rather than what is best for health care in the borough and in the interests of local residents?

David Evennett: I endorse what my hon. Friend says, and I am very concerned about it. It is perceived that finance is the bottom line.
	My concern is whether the other hospitals will be able to meet the need if we close A and E at Queen Mary's. In December last year the Princess Royal hospital in Farnborough had to turn away patients as it was unable to cope with the high demand. Three ambulances were diverted to Queen Mary's for three hours because of the influx of patients on 18 December 2007.
	There was an increase of about 32 per cent. in the number of A and E attendances at Queen Elizabeth hospital in Woolwich between 2001-02 and 2007-08. So I seriously believe that neither hospital could cope with the additional attendees that the closure of QM at Sidcup would cause.
	In 1988 I campaigned vigorously for part of my then constituency of Erith and Crayford to be included in the maternity services catchment area of Queen Mary's hospital because constituents were having to travel a long way for the services that they needed. We were fortunate in that campaign. The Government and the health authority listened, and the campaign was successful. Residents of Crayford were included in that catchment area. I fear that we are now looking at a retrograde step of closing maternity services at Queen Mary's, and other areas of Bexley will experience the same problems as my constituents had in the 1980s.
	Many constituents from Bexley and Sidcup have contacted my office to praise maternity services at the hospital, which are provided by hard-working doctors and nurses and other staff. The unit has an extremely good record. Again, capacity at other hospitals in south-east London is a concern. While more home births are being promotedwhich is good for those who want itthere will be issues for those who prefer hospital care and delivery. I understand that nationally in 2007, 42 per cent. of NHS trusts providing maternity services had to turn away women in labour because they were full. This is a worry that we will have in our area too.
	I know that the Princess Royal hospital had to divert patients from its maternity unit in March due to high activity and capacity issues. These are real concerns. I hope that the Minister will appreciate that we are closing facilities in Queen Mary's hospital in Sidcup when other hospitals are not able to cope. Yet the experts say that those hospitals could cope.
	I have received representations from GPs. They say:
	The plans for Maternity services in both Primary and Secondary care do not seem robust. Bexley will be left with a midwife-led birthing unit at QMH with no Consultant backup on the premises.
	Community midwives are being taken away from individual GP surgeries and grouped into clusters. This will cause great inconvenience to patients at large who will have to travel further for their care. The midwives will be unable to access patients medical records which are a necessary requirement.
	I note that in other parts of the country smaller maternity units are being maintained, so why not in Bexley? My hon. Friend the Member for Bromley and Chislehurst has alluded to the finance, and I will not go over that in view of the shortage of time. Many people believe that the building is safe, but what about the services? The hospital is being downgraded and services cut for financial reasons.
	I should like to ask the Minister a couple of questions. We know that a joint health overview and scrutiny committee referred the decision of the A Picture of Health board to the Secretary of State in the summer. I should like to know when the decision is going to be made. Does the Secretary of State intend to refer the decision to the independent reconfiguration panel to ensure that there is independent scrutiny? We would like to know that independent people have looked at the decision and made a judgment. All of us who are campaigning against the downgrades and closures feel that to date that has not been done. As my hon. Friend said, it looks as if there was a done deal and the consultation was a sham. I hope that the Minister will be able to answer these important issues and that he will tell me positively that the case will go to the IRP.
	The hospital is not the only local health care issue. We have real concerns about the regrettable cuts made by the Bexley Care Trust, whose headquarters is in my constituency. Those cuts affect quality of life. Pensioners, for example, are disadvantaged by cuts to the chiropody service. Many of them now have to pay for the service and travel to clinics rather than have a free service in their home.
	Two years ago, I raised concerns with the Minister's predecessor about plans to redirect family planning services to GPs and about changes to speech and language therapy services. More recently, we have been concerned locally about the lack of NHS dentistry services. Those are quality of life issues.
	When my hon. Friend the Member for Hemel Hempstead (Mike Penning) spoke at the end of the previous debate, he made some important points about polyclinics. Many local pensioners are concerned about how polyclinics will affect them. The closing of GP surgeries in favour of polyclinics could have a considerable effect on early diagnosis rates. We are also concerned that the relationship between pensioners and their doctor will be breached because they will not always see the same doctor.
	Those are the concerns that are being raised locally. The fear is that Queen Mary's hospital may eventually end up as simply a super-polyclinic. That is a real worry to pensioners who rely on their doctor. People get to know their doctor, which makes them feel confident. Elderly people in particular value that relationship.
	I am pleased to have been able to raise these issues with the Minister. Will he give us some reassurance that there is no done deal on Queen Mary's and that there will be independent consideration? South-east London is different from other parts of London; we have particular issues and problems, whether transport or the location of hospitals. We deserve better health care for all the people in Bexley.

Ben Bradshaw: I congratulate the hon. Member for Bexleyheath and Crayford (Mr. Evennett) on securing the debate and I pay tribute to NHS staff in Bexleyheath and Crayford, as well as across the NHS as a whole, for their hard work and dedication, which are delivering a better quality health service than ever, benefiting, not least, the hon. Gentleman's constituents.
	As I am sure the hon. Gentleman will acknowledge, the NHS in south-east London has faced significant historical challenges, many of which are shared across London, as we can see from today's annual Healthcare Commission report. Incidentally, he is not quite correct to say that the commission's annual health check said that health care in London had declined. In fact, it has improved, but more slowly than in the rest of the country. However, he is right that there have for some time been particular challenges in south-east London.
	I hope that the hon. Gentleman will acknowledge, too, that the health service can never stand still; it has to change. Lifestyles, society, medicine and technology are all constantly advancing, which means, for example, that many conditions that used to require admission to hospital can now be treated in the community, by GPs or even in someone's home. For those who require admission to hospital, the average length of stay is just a fraction of what it was even only five years ago.
	Although many services can now be delivered outside a hospital setting, closer to where people live, some more specialist and complex treatments require such a level of expertise, with round-the-clock teams of doctors and nurses, that they are best delivered in a smaller number of major centres. That is the context against which the proposed reorganisation of health care in south-east London is taking place.
	The other thing I need to make clear is that decisions on how local services are organised are no longer made by Ministers in Whitehall, but by autonomous NHS professionals on the ground. I take this opportunity to commend the collaborative approach that has been taken by the four primary care trusts involved in the south-east London reorganisationBexley, Lewisham, Greenwich and Bromleyand the four acute hospital trusts involved, Queen Mary's Sidcup, Bromley Hospitals, Queen Elizabeth and University Hospital Lewisham. It is no mean feat that they have managed to come up with a set of proposals that they believe will ensure safe and high-quality services for the people of their boroughs and an NHS for south-east London that will at long last be put on a stable financial footing.
	The process of drawing up the proposalscalled, as we know, A Picture of Healthhas been led by doctors and other health care professionals and has involved, as the hon. Gentleman knows because he has taken part in it, extensive public consultation. The clear view of the clinicians involved has been that while many services can be devolved further out into local communities, there are others that, because of their speciality, urgency or complexity, need to be concentrated on three rather than four sites to make the most of the available expertise.

John Austin: In his speech, the hon. Member for Bexleyheath and Crayford (Mr. Evennett) often used the word downgrading. Does my hon. Friend share my view that there is a powerful and arguable case for the separation of elective care from trauma services? Is he aware that the proposals for Queen Mary's Sidcup mean that it will become a centre of excellence for elective care, including cancer services, not just for the borough of Bexley but for Greenwich, Lewisham and Bromley as well? Does he consider it correct to describe that as downgrading?

Ben Bradshaw: No, I do not. I have been trying to improve understanding of how health care is organised. There are many services, and many in the case of this reorganisation, that are being delivered and devolved out into the communities; I will come on to the extra services that these proposals are intended to provide at St. Mary's Sidcup in a moment.

David Evennett: Queen Mary's.

Ben Bradshaw: Queen Mary's; I beg the hon. Gentleman's pardon.
	There are other services that, because of their nature, require, for the sake of patient safety and lives saved, to be concentrated in more specialist centres.
	The independent national clinical advisory team, under the respected doctor Professor Sir George Alberti, reviewed the proposed changes in south-east London. Its report said:
	It is obvious that no change is not an option. This has been stressed particularly by hospital clinicians. We support the view of concentrating acute services on fewer sites as soon as possible.
	As I am sure that the hon. Gentleman knows, in July a joint committee of the primary care trusts involved agreed to recommend a variation of a number of the options that had been considered during the public consultation. Its recommendation is for two fully admitting hospitals, Queen Elizabeth in Woolwich and Princess Royal in Orpington, and a medically admitting hospital at University Hospital Lewisham and a borough hospital at Queen Mary's Sidcup. The local NHS has said that it believes that that solution would deliver the most clinical and non-clinical benefits to local people.
	Under the proposals, as my hon. Friend the Member for Erith and Thamesmead (John Austin) has just mentioned, Queen Mary's Sidcup would lose its full A and E department and maternity services, but its urgent care centre would be expanded to provide 24-hour cover, routine surgery would also be expanded to cover not only Bexley but all of Bromley and Greenwich, and there would be an expansion of several community diagnostic and specialist ambulatory services.
	The advantages of those proposals, according to the NHS in south-east London, is that they will bring together small teams that currently provide specialist care, such as emergency and trauma care, into larger teams with the capacity and round-the-clock expertise to provide top-quality and safe care, while other services would be provided closer to people's homes. That will make services easy to access and help to reduce health inequalities and differences in access to care in the area.
	As the hon. Member for Bexleyheath and Crayford is aware, the overview and scrutiny committee of Bexley council, which has the role of monitoring NHS decisions in his area, has formally referred the proposals to the Secretary of State for review. The joint overview and scrutiny committee, comprising six interested boroughs and Kent county council, has indicated its intention to refer at least some of the proposals to the Secretary of State, and I understand that it is meeting shortly to agree the precise terms of any referral. I can assure the hon. Gentleman that in any event the referral by Bexley means, under the independent system set up by the Government, that the national independent review panel will look again at the proposals. As for the process, I suspect that the panel will not wish to consider the referral formally until it hears from the joint overview and scrutiny committee, because it will need to be clear about the exact reasons for the referral, and what its terms are.
	As the hon. Gentleman acknowledged, the panel is genuinely independentfor example, it recently rejected proposed NHS reorganisations affecting East Sussex and Oxfordshire. Anyone, including the hon. Gentleman, and the hon. Members for Hornchurch (James Brokenshire) and for Bromley and Chislehurst (Robert Neill), who are sitting behind him, and my hon. Friend the Member for Erith and Thamesmead, may make representations to the panel. I hope that that has gone some way to reassure the hon. Member for Bexleyheath and Crayford that the decisions that are being taken on health in his local area are being led by the local NHS and clinicians, and are aimed at trying to provide his constituents and the rest of the public in south-east London with the modern, safe and high-quality health services which I hope we all agree they deserve.
	 Question put and agreed to.
	 Adjourned accordingly at twenty-f ive minutes past Six o'clock.